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