Clinical Practice Guidelines In treating children with Acute Otitis Media
Acute Otitis Media
Inflammation of the middle ear due to infection.
Full Answer
Should antibiotics be prescribed for acute otitis media?
6 rows · · Otitis media with effusion is defined as middle ear effusion in the absence of acute symptoms. ...
What is the first line treatment for otitis media?
Objective: "Clinical Practice Guidelines for the Diagnosis and Management of Acute Otitis Media in Children-2018 update (2018 Guidelines)" aim to provide appropriate recommendations about the diagnosis and management of children with acute otitis media (AOM), including recurrent acute otitis media (recurrent AOM), in children under 15 years of age. These evidence-based …
Would azithromycin cure acute otitis media?
25 rows · · Guidelines were included if they met the following eligibility criteria: (1) they were pertaining ...
Can otitis media be cured without antibiotics?
Otitis Media: Clinical Practice Guidelines and Management ... Identify the common pathogens, clinical presentation, indications for referral, clinical practice guidelines, best treatment …
How do you diagnose otitis media?
How is otitis media diagnosed? In addition to a complete medical history and physical examination, your child's health care provider will inspect the outer ear(s) and eardrum(s) using an otoscope. The otoscope is a lighted instrument that allows the health care provider to see inside the ear.
What is a strong recommendation in the clinical practice guidelines for prevention of AOM?
Recommendation 2 The management of AOM should include an assessment of pain. If pain is present, the clinician should recommend treatment to reduce pain. (This is a strong recommendation based on randomized clinical trials with limitations and a preponderance of benefit over risk.)
What treatments are used to treat otitis media?
High-dose amoxicillin (80 to 90 mg per kg per day) is the antibiotic of choice for treating acute otitis media in patients who are not allergic to penicillin.
What is the best tool for diagnosing otitis media?
The device is an optical coherence tomography otoscope that analyzes reflected light from the middle ear space to determine whether an infusion is present. Studies have shown that the device is very accurate in diagnosing OME.
How is otitis media treated in adults?
A middle ear infection may be treated with:Antibiotics, taken by mouth or as ear drops.Medication for pain.Decongestants, antihistamines, or nasal steroids.For chronic otitis media with effusion, an ear tube (tympanostomy tube) may help (see below)
What is watchful waiting otitis media?
Middle ear infection (acute otitis media) is an infection in the middle ear, or behind the eardrum. What does the term “watchful waiting” mean? It means observing your child for 2–3 days to give your child's immune system time to fight off the infection rather than starting antibiotics immediately.
What is the first line treatment for otitis media?
Amoxicillin at a dosage of 80 to 90 mg per kg per day should be the first-line antibiotic for most children with acute otitis media. Patients with otitis media who fail to respond to the initial treatment option within 48 to 72 hours should be reassessed to confirm the diagnosis.
What is otitis media differential diagnosis?
DIFFERENTIAL DIAGNOSIS The differential diagnosis of acute otitis media (AOM) includes otitis media with effusion (OME), chronic otitis media (COM), external otitis (otitis externa), herpes zoster infection, and other deep space head and neck infections.
What is the best treatment for chronic otitis media?
The only treatment for chronic otitis media and cholesteatoma is a surgery called tympanoplasty with mastoidectomy. There are no medicines that will cure these diseases. The primary goal of surgery for chronic otitis media and cholesteatoma is to remove all infection and cholesteatoma.
What type of antibiotics are used for ear infections?
Here are some of the antibiotics doctors prescribe to treat an ear infection:Amoxil (amoxicillin)Augmentin (amoxicillin/potassium clavulanate)Cortisporin (neomycin/polymxcin b/hydrocortisone) solution or suspension.Cortisporin TC (colistin/neomycin/thonzonium/hydrocortisone) suspension.More items...•
Who uses an otoscope?
Health care providers use otoscopes to screen for illness during regular check-ups and also to investigate ear symptoms. An otoscope potentially gives a view of the ear canal and tympanic membrane or eardrum.
Why does the clinician use Otoscopic examination?
The purpose of otoscopic examination is to evaluate the condition of the ear canal, tympanic membrane and the middle ear. However, the ear canal and tympanic membrane are not easy to examine because of their relative inaccessibility and the need for both magnification and illumination.
What are the symptoms of otitis media?
1 Nonspecific symptoms of acute otitis media (e.g., fever, headache, irritability, cough, rhinitis, listlessness, anorexia, vomiting, diarrhea, pulling at the ears) are common in infants and young children. Otalgia is less common in children younger than two years and more common in adolescents and adults. 4 Acute otitis media cannot be reliably differentiated from upper respiratory tract infection on the basis of symptoms alone. 10 However, otalgia, ear rubbing or pulling, and parental suspicion of otitis media have positive likelihood ratios (LR+) of 3.0 or more and are moderately useful for ruling in the diagnosis ( Table 4 12 – 16 ). 12, 13
What is the best antibiotic for otitis media?
1, 22. Amoxicillin at a dosage of 80 to 90 mg per kg per day should be the first-line antibiotic for most children with acute otitis media. B. 1. Patients with otitis media who fail to respond to the initial treatment option within 48 to 72 hours should be reassessed to confirm the diagnosis.
How to detect middle ear effusion?
Detection of middle ear effusion by pneumatic otoscopy is key in establishing the diagnosis of acute otitis media. The tympanic membrane normally is convex, mobile, translucent, and intact; a normal color and mobility of the membrane indicate that otitis media is unlikely (negative likelihood ratio [LR–], 0.03). 10 A bulging membrane greatly increases the likelihood of otitis media (LR+, 20.3), as do impaired mobility of the membrane (LR+, 4.7) and a distinctly red membrane (LR+, 2.6), albeit to a lesser extent. 14
What is the risk factor for persistent ear effusion?
Risk factors for persistent acute otitis media with effusion include hearing loss greater than 30 dB, prior tympanostomy tube placement, adenoid hypertrophy, and onset during summer or fall. 34
How many doses of ceftin for otitis media?
Cefuroxime (Ceftin) 30 mg per kg per day, given orally in two divided doses.
How long does it take for otitis media to resolve?
20 Most children with acute otitis media (70 to 90 percent) have spontaneous resolution within seven to 14 days; therefore, antibiotics should not routinely be prescribed initially for all children. 21, 22 Delaying antibiotic therapy in selected patients reduces treatment-related costs and side effects and minimizes emergence of resistant strains. 23
What is the most common bacterial isolate from the middle ear fluid?
Diagnostic criteria for acute otitis media include rapid onset of symptoms, middle ear effusion, and signs and symptoms of middle ear inflammation. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common bacterial isolates from the middle ear fluid ...
What are the management considerations for otitis media?
Additional management considerations might include (a) the provision of information on optimizing auditory-based communication strategies during bouts of otitis media when hearing sensitivity might be compromised ; (b) the monitoring of auditory behaviors which might signal subsequent episodes of otitis media ; and (c) suggestions for optimizing the classroom environment for all children who might experience “minimal fluctuant hearing loss” through the reduction of classroom noise and/or the provision of soundfield amplification systems.
What is the identification process for otitis media?
That the identification process includes screening of hearing, middle ear function, and communication development, particularly in “at-risk” populations. Such groups would include infants who develop otitis media at or before the age of six months, infants and young children care for in multi-child day care settings, and infants and children with known risk factors such as those with cleft lip or palate, native Americans, or those with Down Syndrome.
Why is audiometric assessment necessary?
Thus, audiometric evaluation is the only means of determining hearing sensitivity. Because hearing sensitivity is directly related to communication ability , routine audiometric assessment is necessary to identify children who require aggressive management to maintain their hearing within normal limits.
How long does middle ear effusion last?
Children who have had middle ear effusion which persists for three months despite medical treatment, should be given monitoring hearing screenings, routine tympanometry, and language and speech screenings. Those children who fail any of these screening procedures should be referred for complete assessment with in-depth testing. Those children for whom communication skills are found to be delayed or abnormal, may need more assertive medical attention, and possibly appropriate communication therapy from a certified/licensed speech-language pathologist.
When should hearing assessments be completed?
In particular, hearing assessment should be completed at the onset of the school year in pre-school and elementary students, and at least once during the winter months.
Is otitis media a developmental problem?
The American Academy of Audiology considers that developmental deficits in communication and behavioral/attention problems experienced by some children with recurrent otitis media are, for the most part, auditory-based. There is increasing evidence that the age of onset, as well as the nature, degree, and configuration of the peripheral conductive hearing loss which occurs secondary to otitis media, are critical components that place children at risk for developing communication and learning disorders. Early identification and management of hearing loss associated with otitis media is important for optimum developmental outcome. Thus, any Clinical Practice Guidelines developed for the diagnosis and treatment of otitis media in children, must specifically include audiologic assessment and management as integral components.
Is there a causal relationship between otitis media and communication disorders?
We are convinced, from careful analysis of the voluminous research available, that a causal relationship does exist between communication disorders and early, recurrent, episodes of otitis media in infants and young children. Accordingly, we feel it is important to participate in this public meeting regarding the development of clinical practice guidelines for the diagnosis and treatment of this pathology and hearing disorder. Our Academy believes that while the disease process itself must be medically and surgically managed by physicians, the identification, assessment and management of any concomitant hearing loss falls within the scope of audiologic practice.
What is the focus of the AOM practice guideline?
The focus of this practice guideline is the appropriate diagnosis and initial treatment of a child presenting with AOM. The guideline provides a specific, stringent definition of AOM. It addresses pain management, initial observation versus antibiotic treatment, appropriate choices of antibiotic agents, and preventive measures. It also addresses recurrent AOM, which was not included in the 2004 guideline. Decisions were made on the basis of a systematic grading of the quality of evidence and benefit-harm relationships.
Does the practice guideline have peer review?
The practice guideline underwent comprehensive peer review before formal approval by the AAP.
How often should you evaluate tympanic membranes?
Evaluate tympanic membranes at every well-child and sick visit if feasible; perform pneumatic otoscopy or tympanometry when possible (consider removing cerumen)If transient effusion is likely, reevaluate at three-month intervals, including screening for language delay; ifthere is no anatomic damage or evidence of developmental or behavioral complications, continue to observe at three- to six-month intervals; if complications are suspected, refer to an otolaryngologist For effusion that appears to be associated with anatomic damage, such as adhesive otitis media or retraction pockets, reevaluate in four to six weeks; if abnormality persists, refer to an otolaryngologistAntibiotics, decongestants, and nasal steroids are not indicated
What is AOM in ear?
Usually, AOM is a complication of eusta-chian tube dysfunction that occurred during an acute viral upper respiratorytract infec-tion. Bacteria can be isolated from middle ear fluid cultures in 50% to 90% of cases of AOM and OME. Streptococcus pneumoniae, Haemophilus influenzae (nontypable), and Moraxella catarrhalis are the most common organisms.3,4 H. influenzae has become the most prevalent organism among children with severe or refractory AOM following the introduction of the pneumococcal con-jugate vaccine.5-7 Risk factors for AOM are listed in Table 1.8,9