AOM
Otitis Media Otitis Media with effusion (OME) Acute Otitis Media (AOM) Recurrent AOM Chronic Otitis Media/Chronic Otitis Media with effusion Chronic Suppurative Otitis Media (CSOM)
Epidemiology Seasonal Peak: winter months 90% of children have at least one symptomatic or asymptomatic episode by 2yrs of age Incidence Peaks: 6-18months of age
Risk Factors Age <2yrs Atopy Bottle propping Chronic sinusitis Ciliary dysfunction Cleft palate and craniofacial anomalies Child Care attendance Down Syndrome and other genetic conditions
Pathogenesis Impaired eustachian tube function Negative pressure increases Nasopharyngeal contents are aspirated into middle ear Increased vascular permeability: development of MEE
Viruses RSV Paraflu (types 1,2,3) Influenza (type A and B) Adenovirus Coronavirus
Bacteria Streptococcus Pneumoniae Nontypeable Hemophilus influenza Moraxella catarrhalis S. pyogenes (Group A strep) Staph Aureus (less common)
PE: OME vs AOM Fluid in middle ear space AOM: inflammation, specifically otalgia and fever OME: TM appears opaque or cloudy AOM: red or dark-yellow discoloration of TM or bulging of TM
Normal TM
OME
AOM
Management Observation Treatment
Management <6months: antibacterial therapy 6months to 2years with certain diagnosis: antibacterial therapy 6months to 2 years with uncertain diagnosis: antibacterial therapy or observation 2yrs and up with certain diagnosis: antibacterial therapy or observation 2yrs and up with uncertain diagnosis: observation
Antibiotic High dose amoxicillin: 80-90mg/kg/day Alternative for penicillin allergy Augmentin 90mg/kg per day of amox component Ceftriaxone Clindamycin
Complications Mastoiditis Acute labyrinthitis Petrositis Meningitis Brain Abscess Epidural Abscess Otitic hydrocephalus