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Signs and symptoms predicting acute otitis media.

Seldom have I been as shocked to read the conclusions of a medical journal article than I was reading those by Heikkinen and Ruuskanen1in the January issue of theArchives. Since the symptoms did not reliably predict which children with colds had acute otitis, the authors conclude that "all children at risk for acute otitis media should be examined during upper respiratory tract infection, and if respiratory symptoms persist for several days after the initial visit, a reexamination should be performed." The authors make the assumption that every ear effusion of acute onset represents an infection. Their assumption was not verified with tympanocentesis, nor was an attempt made to randomize children with effusion to antibiotic treatment and control groups to assess outcome. Research has shown that occlusion of the eustachian tube in germ-free animals results in the accumulation of sterile fluid within the middle ear within 2 days