Acute otitis media

Background

• Peak incidence: 6-18 months of age
• Etiology
  • S. pneumo (30%)
  • Nontypable H. flu (55%)
  • Moraxella (5-10%)

Diagnosis

• Acute Otitis Media
  • 1. Acute onset (<48hr) and
  • 2. Middle ear effusion and
  • 3. Signs of middle ear inflammation

• acute onset <48 hours, chronic cases should be followed by PMD as may represent differnet diagnostic entity
• Middle Ear Effusion: bulging TM, otorrhea, anair/fluid level behind TM, or limited or absent TM mobility
• Middle Ear inflammation: erythema, of the TM or otalgia, but also need above symptoms
• Note: Please clean ear of cerumen with 1:1 solution peroxide and water and curette

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 sxs >72hr after amox begun (covers moraxella, nontypeable H. flu)
         2. Clavulanate increases vomiting/diarrhea
      3. Azithromycin
         1. Consider if penicillin allergic
      4. CTX
         1. Use if cannot tolerate PO

See Also

Otitis Externa

Source

Tintinalli