Acute otitis media

Background

• Peak incidence: 6-18 months of age
• Etiology
  • Viral (70% of cases)
  • Bacterial
    • S. pneumo (50%)
    • Nontypable H. flu (30%)
    • Moraxella (30%)

Diagnosis

1. Acute onset (<48hr) AND
2. Middle ear effusion AND
3. Signs of middle ear inflammation
4. Notes
   1. Middle Ear Effusion: bulging TM, impaired TM movement, otorrhea, or air/fluid level
   2. Middle Ear inflammation: erythema of TM or otalgia

DDX

Common

• Acute otitis media
• Chronic otitis media
• Serous otitis media
• Foreign body in external ear canal
• Otitis externa

Less common

• Accidental trauma
• Oral cavity disease (referred pain)
• Cholesteatoma
• PTA

Rare

• Mastoiditis
• Brain abscess
• Lemierre syndrome
• Herpes zoster oticus

Treatment

1. Analgesia
   1. Acetaminophen/ibuprofen and topical benzocaine (unless perforated TM)
2. Antibiotics
   1. Indications:
      1. Age <6mo
      2. Ill-appearing
      3. Recurrent acute otitis media (w/in 2-4wk)
      4. Concurrent abx tx
      5. Other bacterial infections
      6. Immunocompromised
      7. Craniofacial abnormalities
   2. Wait-and-see antibiotic prescription
      1. If symptoms worsen or persist x48-72 then family fills the Rx
   3. Agent
      1. Amoxicillin 80-90mg/kg/day divided into 2 daily doses x5-7days
         1. 1st line
      2. Amoxicillin-clavulanate
         1. Consider if symptoms persist >72hr after amox begun
         2. Clavulanate increases vomiting/diarrhea
      3. Azithromycin
         1. Consider if penicillin allergic
      4. CTX
         1. Use if cannot tolerate PO

Complications

1. Mastoiditis
2. Meningitis
3. Brain Abscess
4. Lateral Sinus Thrombosis

See Also

Otitis Externa

Source

• Tintinalli