Acute Otitis Media

Acute Otitis Media 

I see so many ear pain everyday, however, I still feel that I don't have a good grasp on this topic. Parents are often anxious and pushing for antibiotics. I believe that GPs do have a standard to uphold and should only prescribe it only when it is clinically indicated. 

Key Points:

- The diagnosis of AOM is difficult to make especially in children under the age of 3. Studies have shown that the accuracy was: ENT surgeons 74%, paediatricians 51% and GPs 46%.

- Recurrent otitis media is 3 or more episodes in 6 months or 4 or more in 12 months. 

- Common organisms which cause AOM are: streptococcal pneumoniae, Haemophilus influenza-nontypeable and moraxella catarrhalis. 

- Treatment of AOM involves the following:

• Adequate analgesia: paracetamol, amethocaine, benzocaine or lidocaine.
• Antibiotic therapy recommendations:
• well, older than 2 years, no ABx for 48hrs
• Children under the age of 2 as they are more likely to develop complications
• children with severe illness with pain, or a tympanic membrane perforation 
• a child with known immunodeficiency 
• indigenous children, including aboriginal, Torres Strait islander and Maori and other Pacific Islander children
• Children with a cochlear implant
• antibiotic regime: amoxycillin 15mg/kg 3 times per day x 5days; allergic to penicillin, use cefuroxime 10mg/kg to 500 mg twice per day for 5 days or ceflacor 10mg/kg up to 250 mg 3 x per day for 5 days
• topical antibiotics (mainly ciprofloxacin) can be used with tympanic membrane perforation
• Vaccination with the polyvalent pneumococcal vaccine reduces the incidence of am BY 8 % 

- Prevention of recurrent otitis media

• avoid childcare
• avoid smoking 
• breastfeed x 6 months to 12 months
• avoid pacifiers/dummies
• polyvalent pneumococcal vaccines
• 2 weeks after an episode of AOM, 70% of children will have middle ear effusion but most perforation would have healed.
• Treating blocked nose may not help with acute otitis media. Saline to clear the nose and steroid spray to reduce the size of adenoid
• Adenoidectomy has not been shown to be effective in preventing recurrent AOM

References:

- Check program : ENT