Otitis Media and Fever

John M. Goldenring, MD. MPH
JAMA. 1982;247(7):978. doi:10.1001/jama.1982.03320320018012.
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To the Editor.—  The recent article by Schwartz et al (1981;245:2057) provides strong evidence for the commonly held belief that high fever and acute otitis media are seldom associated. However, the article does not discuss why a few children do experience high fevers with otitis. I have been taught that the association of high fever and otitis occurs if one of three conditions is met: (1) there is an idiosyncratically exaggerated febrile response; (2) there is an intercurrent viral illness with viremia; or (3) there is a concurrent bacteremia.The work of the last decade1,2 has shown that unsuspected bacteremia with high fever occurs commonly in young children at an age when they are also prone to otitis media and that the most common organisms in both conditions are Haemophilus influenzae and pneumococcus. Otitis has been shown definitely to occur in association with bacteremias with both organisms.1,3 I


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