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Otitis%20media%20-%20acute%20(pediatric) Management
Prevention
- Breastfeeding for at least 4-6 months, avoiding supine bottle feeding, exposure to persons with respiratory infections and tobacco smoke, and reducing pacifier use after 6 months of age may help prevent acute otitis media (AOM)
- Pneumococcal conjugate vaccine may help in preventing vaccine-serotype pneumococcal otitis media
- Introduction of PCV7 use significantly decreased carrier rate and incidence rate of AOM caused by S pneumoniae
- Recommended as a 3-dose series given at 4-week intervals with booster dose given at 12-15 months of age for primary immunization
- Annual influenza vaccine is recommended for all children ≥6 months of age for the prevention of AOM
- Two doses separated by a 4-week interval should be administered to children 6 months to 8 years receiving influenza vaccine for the 1st time, then 1 dose yearly after initial dose
- Further studies are needed to prove effectiveness of birch sugar (5-carbon polyol sugar alcohol) in prevention of acute and recurrent AOM
Expert Referral
Consider referral to pediatric infectious disease specialist if any of the following occurs:
- If no response to 2nd-line agents
- Tympanocentesis with Gram stain and culture is recommended
- Otitis media with effusion (OME) for ≥3 months with bilateral hearing loss ≥20 dB
- ≥3 episodes in 6 months; ≥4 episodes in 12 months
- Retracted tympanic membrane (rule out significant pathology like cholesteatoma)
- Complications of acute otitis media (AOM)
- Speech or language delay
- Patients with 3 episodes of AOM within 6 months, or 4 episodes within 1 year with 1 episode in the last 6 months, should be referred for tympanostomy tube placement
Follow Up
- Clinicians should determine appropriate follow-up
- Parent initiated follow-up visit or telephone call to clinic if worsening condition or no improvement at 48-72 hours
- Routine follow-up call from clinic to patient 48-72 hours after initial visit
- Scheduled follow-up appointment in 48-72 hours
- Use of provisional antibiotic prescription with directions only if illness does not improve or worsens within 48-72 hours
- Follow-up exam of asymptomatic patients at the completion of treatment is not necessary
- It is recommended that follow-up exam is done 4-8 weeks after diagnosis
- Middle ear effusion (MEE) can persist for up to 1-3 months even if there is bacteriologic cure
- Persistence of MEE is not an indication for continued treatment or for another course of antibiotics
- Hearing test should be performed if effusion is present 3 months post-acute otitis media (AOM)
- Refer to otolaryngologist if hearing loss persists
- Defined as the presence of tympanic membrane bulging and inflammation of the middle ear after completion of therapy for AOM
- ≥3 separate episodes of AOM within 6 months or ≥4 episodes in a year with 1 episode in the past 6 months
- Prophylactic antibiotic use is recommended for the prevention of recurrent AOM
- Recommended antibiotics include Amoxicillin/clavulanic acid, Ceftriaxone, and Levofloxacin
- Tympanostomy tube placement should be considered in children with ≥3 episodes of AOM within 6 months or ≥4 episodes in a year
