Acute otitis media symptoms and symptom scales in research with Aboriginal and Torres Strait Islander children

Penelope Abbott; Caitlin Frede; Wendy C Y Hu; Sanja Lujic; Steven Trankle; Letitia Campbell; Hasantha Gunasekera; Robyn Walsh; Amanda J Leach; Peter Morris; Kelvin Kong; Jennifer Reath

doi:10.1371/journal.pone.0280926

Acute otitis media symptoms and symptom scales in research with Aboriginal and Torres Strait Islander children

PLoS One. 2023 Feb 23;18(2):e0280926. doi: 10.1371/journal.pone.0280926. eCollection 2023.

Authors

Affiliations

¹ Department of General Practice, Western Sydney University, Campbelltown, New South Wales, Australia.
² Medical Education Unit, School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.
³ Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.
⁴ Kalwun Development Corporation, Gold Coast, Queensland, Australia.
⁵ Children's Hospital Westmead Clinical School, Sydney University, Sydney, New South Wales, Australia.
⁶ Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.
⁷ School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.

Abstract

Background: Aboriginal and Torres Strait Islander children experience a high burden of otitis media. We collected data on symptoms associated with acute otitis media (AOM) in a clinical trial involving children receiving primary care at urban Aboriginal Medical Services. Two scales were employed to monitor symptoms over time: the AOM-Severity of Symptoms scale (AOM-SOS) and the AOM-Faces Scale (AOM-FS). This study took place at a mid-point of the un-blinded trial.

Methods: We examined symptoms at enrolment and day 7, and compared the scales for trends, and bivariate correlation (Spearman's rho) over 14 days. Responsiveness of the scales to clinical change was determined by Friedman's test of trend in two subgroups stratified by day 7 AOM status. We interviewed parents/carers and research officers regarding their experience of the scales and analysed data thematically.

Results: Data derived from 224 children (18 months to 16 years; median 3.6 years). Common symptoms associated with AOM at baseline were runny nose (40%), cough (38%) and irritability (36%). More than one third had no or minimal symptoms at baseline according to AOM-SOS (1-2/10) and AOM-FS scores (1-2/7). The scales performed similarly, and were moderately correlated, at all study points. Although scores decreased from day 0 to 14, trends and mean scores were the same whether AOM was persistent or resolved at day 7. Users preferred the simplicity of the AOM-FS but encountered challenges when interpreting it.

Conclusion: We found minimally symptomatic AOM was common among Aboriginal and Torres Strait Islander children in urban settings. The AOM-SOS and AOM-FS functioned similarly. However, it is likely the scales measured concurrent symptoms related to upper respiratory tract infections, given they did not differentiate children with persistent or resolved AOM based on stringent diagnostic criteria. This appears to limit the research and clinical value of the scales in monitoring AOM treatment among Aboriginal and Torres Strait Islander children.

Copyright: © 2023 Abbott et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Australian Aboriginal and Torres Strait Islander Peoples
Child
Health Services, Indigenous*
Humans
Otitis Media* / diagnosis
Parents
Respiratory Tract Infections*

Grants and funding

Funding for this study was received from the Centre of Research Excellence in Ear and Hearing Health of Aboriginal and Torres Strait Islander Children (http://purl.org/au-research/grants/nhmrc/1078557, authors PA, JR, LC) and the Australian Government National Health and Medical Research Council (https://www.nhmrc.gov.au), grant number GTN1046266, authors JR, PA, HG, AL, KK, PM. The funders did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.