Features of clinical course and diagnosis in pediatric otitis media with ARVI

Acute otitis media remains one of the most frequent infectious diseases in paediatric practice, with growing concerns about antibiotic resistance necessitating precise diagnostic and therapeutic approaches. The aim of this study was to establish age-specific aetiological patterns and develop evidence-based criteria for the differential diagnosis of otitis media in children with acute upper respiratory infections. A prospective observational study included 68 patients aged 1 to 13 years. The study demonstrated a clear age-dependent aetiological pattern: viral causes predominated in younger children (67.9% among infants, 63.2% in early childhood, 53.8% in middle childhood), whereas bacterial infections were more prevalent in older children (57.1% in late childhood and 100% in adolescence). Temperature patterns showed a strong correlation with aetiology: subfebrile temperatures (37.1-38.0 °C) were typically associated with viral infections (64.7% of cases), whereas febrile (38.1-39.0 °C) and high febrile temperatures (> 39.0 °C) were characteristic of bacterial infections (54.2% and 20.8%, respectively). Video endoscopy successfully differentiated three main clinical-morphological forms: secretory otitis (38.2%, predominantly viral), acute purulent otitis (35.3%, bacterial), and bullous otitis (26.4%, predominantly viral). Key clinical predictors of a complicated disease course included age under three years, recurrent otitis history, high fever, otorrhoea, hearing loss, and systemic signs of intoxication. Treatment strategies emphasised rational antibiotic use, with amoxicillin as first-line therapy for bacterial cases and symptomatic management for viral aetiology. This study establishes an individualised diagnostic algorithm based on age, temperature patterns, and endoscopic findings, enabling clinicians to optimise treatment decisions and reduce inappropriate antibiotic prescribing. The practical value of this research lies in providing evidence-based tools for paediatricians and otolaryngologists to improve diagnostic accuracy, enhance treatment outcomes, and contribute to antimicrobial stewardship in the management of paediatric otitis media