Acute Otitis Media (AOM) and treatment

Question 1

What is Acute Otitis Media

Answer 1

sudden onset of ear pain with middle ear effusion, erythema with moderate to severe bulging of the TM, or a new onset of otorrhea not caused by otitis externa.

Question 2

What assessment findings will you find with AOM?

Answer 2

moderate or severe otalgia (tugging, pulling or rubbing of ear)
irritability
INTENSE erythema of the TM (definitive characteristic)
Decreased TM mobility (hypomobility)
distorted landmarks
displaced light reflex
cloudy, dull or opaque TM
moderate to severe BULGING of TM
fever: temp > 102.2
nausea and vomiting
dizziness and diminished hearing
otorrhea or discharge if perforation
ear drum can be yellow/amber with serous otitis media (pre cursor to AOM)

Question 3

What assessment findings do you see with Otitis media with effusion?

Answer 3

usually asymptomatic
Dull TM
Decreased motility
visible air fluid interface
visible air bubbles
diminished hearing

Question 4

Do you treat Otitis media with effusion with antibiotics?

Answer 4

NO

Question 5

Acute Otitis Media

Answer 5

supparative (purulent) effusion of the TM, infection with pus formation behind the TM

Question 6

Bullous myringitis

Answer 6

bullae form between the layers of the TM, pressing outward into ear canal

Question 7

Persistent Acute OM

Answer 7

the treated acute OM never gets better or returns within 1-2 days after finishing antibiotics

Question 8

Recurrent acute OM

Answer 8

three separate cases of acute otitis media in six months or six cases within 12 months
Needs referral to ENT for possible tympanostomy ear tubes

Question 9

Where do central perforations of the ear drum occur?

Answer 9

Pars tensa

Question 10

Marginal perforations occur here?

Answer 10

annulus in the upper region of the ear

Question 11

How long do tympanostomy tubes last before they fall out of the ear?

Answer 11

12-18 months

Question 12

Pearly white or cheese-like lesion embedded in the TM

overgrowth of the epidermal tissue in the middle ear

Answer 12

Cholesteatoma

Question 13

What are signs of cholesteatoma?

Answer 13

tinnitus (ringing in the ear)
unilateral conductive hearing loss
discharge in the canal
** if patient has these symptoms refer to ENT

Question 14

Does scarring of the TM affect hearing or cause long term effects?

Answer 14

NO

Question 15

Diagnosis of Acute Otitis Media should be made if these features are seen?

Answer 15

Middle ear effusion
bulging
Poor mobility
Air fluid level
discharge
cloudiness of the TM
Signs of middle ear inflammation: like erythema and otalgia indicate an ear infection and should be treated.

Question 16

What three components are required by the AAP and AAFP clinical practice guidelines for the diagnosis of Acute Otitis Media?

Answer 16

• Recent, abrupt onset of signs and symptoms of middle ear inflammation and effusion (i.e. ear pain, irritability, otorrhea and/or fever)
• Middle ear effusion (MEE) as confirmed by Bulging TM; limited or absent mobility by pneumatic otoscopy; air-fluid level behind TM; otorrhea
• Signs and symptoms of middle ear inflammation as confirmed by distinct ERYTHEMA of the TM or distinct otalgia interfering with normal sleep or activity.

Question 17

What criteria must be met to ONLY do observation in child with AOM?

Answer 17

Parent must be able to 
communicate with clinician
obtain the antibiotics if needed
bring child in for re-evaluation in 48-72 hours
Child must be otherwise healthy and:
6 months-2 years with non severe illness AND uncertain diagnosis OR
2 years old without severe symptoms OR
an uncertain diagnosis

Question 18

What is criteria for treatment in infants <6 months?

Answer 18

Antibacterial therapy with certain AND uncertain diagnosis and analgesics

Question 19

What is criteria for treatment of child 6 months- 2 years with AOM

Answer 19

Certain diagnosis= antibacterial therapy

Uncertain diagnosis= antibacterial therapy if severe illness; observation option if non severe illness; analgesics

Question 20

What is criteria for treatment of child > 2 years with AOM?

Answer 20

certain diagnosis: antibacterial therapy if severe illness; observation option if non severe illness
Uncertain diagnosis: observation option and analgesics

Question 21

What is treatment of AOM if child <2 years old

Answer 21

treat with amoxicillin 90mg/kg/day for 10 days

if this doesn’t work then step up to Augmentin

Question 22

What is treatment of AOM if child >2 years old

Answer 22

treat with amoxicillin 90mg/kg/day for 5 days

Question 23

What are analgesics used for pain control of AOM?

Answer 23

acetaminophen
ibuprofen >6 months of age
warm or cold oil
distraction
auralgan (ONLY with intact TM)

Question 24

What are ways parents can prevent AOM?

Answer 24

breastfeeding
licensed daycare with fewer children
avoidance of supine bottle feeding
avoid pacifier use > 6 months of age
eliminate smoke exposure