Otitis media is a common ear infection in children caused by dysfunction of the eustachian tube during respiratory infections. Diagnosis involves examining the ear for bulging or fluid and ruling out other causes. Observation without antibiotics may be appropriate for mild unilateral cases. Antibiotics are recommended for severe symptoms, young children, or bilateral infections. Recurrent or persistent cases may require tubes to prevent hearing loss or frequent antibiotics. Probiotics can help reduce recurrence.

1. Otitis Media: Diagnosis
and Treatment
Mahmood AL-Haddabi
R1

2. Outline
 Introduction.
 Risk Factors.
 Diagnosis
 Management

3. Introduction
 AOM is a complication of eustachian tube
dysfunction that occurred during an acute
viral/bacterial upper respiratory tract
infection.

4.  80% of children will have at least one
episode of acute otitis media (AOM).
 Bacteria can be isolated from middle ear fluid
cultures in 50% to 90% of cases

6. Diagnosis
 moderate to severe bulging of the tympanic
membrane + new onset of otorrhea not
caused by Otitis externa.
OR
 mild bulging of the tympanic membrane +
recent onset of ear pain (less than 48 hours) or
erythema

7.  AOM should not be diagnosed in children
who do not have objective evidence of middle
ear effusion

9. OME
 middle ear effusion in the absence of acute
symptoms.
 If effusion on otoscopy is not evident,
pneumatic otoscopy, tympanometry, or both
should be used

10.  Pneumatic otoscopy and Tympanometry has a
sensitivity and specificity of 70-90% for each
for the detection of middle ear fluid.
 By comparison, simple otoscopy is 60% to
70% accurate

11.  Acoustic reflectometry has lower sensitivity
and specificity .
 Tympanocentesis is the preferred method for
detecting the presence of middle ear effusion
and documenting bacterial etiology.

12. Management of AOM
 ANALGESICS :
 recommended for ear pain, fever, and
irritability.
 Ibuprofen is preferred .
 Topical analgesics, such as benzocaine, can
also be helpful

13. OBSERVATION VS. ANTIBIOTIC THERAPY
 Antibiotics should be routinely prescribed for:
1) children with AOM who are 6 months or older
with severe signs or symptoms:
 moderate or severe otalgia.
 otalgia for at least 48 hours.
 temperature of 102.2°F [39°C] or higher

14. 2) children younger than two years:
 With bilateral AOM regardless of additional
signs or symptoms

15.  observation may be an option in:
 6-23 months of age with unilateral AOM.
 two years or older with bilateral or unilateral
AOM

16.  A large prospective study of this strategy
found that two out of three children will
recover without antibiotics.
 AAFP recommended not prescribing
antibiotics for OM in children 2 to 12 years of
age with non-severe symptoms if observation
is a reasonable option.

17.  a mechanism must be in place to ensure
appropriate treatment if symptoms persist for
more than 48 to 72 hours

18. ANTIBIOTIC SELECTION

19.  High-dose azithromycin (Zithromax; 30 mg
per kg, single dose) appears to be more
effective than the commonly used 5 days
course, and has a similar cure rate as high-
dose amoxicillin/clavulanate.
 excessive use of azithromycin is associated
with increased resistance

20.  Trimethoprim/sulfamethoxazole is no longer
effective for the treatment of AOM due to
evidence of S. pneumoniae resistance

21.  Antibiotic therapy for AOM is often
associated with diarrhea.
 Probiotics and yogurts should be suggested.

22. PERSISTENT OR RECURRENT AOM
 If symptoms recur more than one month after
the initial diagnosis of AOM, a new and
unrelated episode of AOM should be assumed

26.  For children with recurrent AOM with middle
ear effusion, tympanostomy tubes may be
considered to reduce the need for systemic
antibiotics/

27.  tympanostomy tubes may:
 increase the risk of long-term tympanic
membrane abnormalities.
 reduced hearing compared with medical
therapy

28.  Probiotics, particularly in infants, have been
suggested to reduce the incidence of
infections during the first year of life.

29. Management of OME
 Tympanostomy Tube Placement
1) for children 6 months to 12 years of age who
have had bilateral OME for 3 months or
longer with documented hearing difficulties

30. 2) children with recurrent AOM who have
evidence of middle ear effusion at the time of
assessment for tube candidacy

31.  Children with chronic OME who did not
receive tubes should be reevaluated every
three to six months

32.  Children with tympanostomy tubes who
present with acute uncomplicated otorrhea
should be treated with topical antibiotics and
not oral antibiotics.

33.  Routine, prophylactic water precautions such
as ear plugs, headbands, or avoidance of
swimming are not necessary for children with
tympanostomy tubes

34. Reference
 AAFP October 1, 2013 ◆ Volume 88,
Number 7