From the Guidelines
Acute Otitis Media (AOM) is a type of middle ear inflammation characterized by the presence of fluid in the middle ear, along with signs and symptoms of an acute infection, such as ear pain, fever, and bulging of the tympanic membrane.
Definition and Diagnosis
- AOM is defined as the rapid onset of signs and symptoms of inflammation in the middle ear, including moderate-to-severe bulging of the tympanic membrane, ear pain, and fever 1.
- Diagnosis depends on typical signs and symptoms, such as acute ear pain and bulging of the tympanic membrane, as well as diagnostic modalities like pneumatic otoscopy, tympanometry, and audiometry 1.
Causes and Risk Factors
- AOM can be caused by bacterial or viral infections, with Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis being the most common bacterial causes 1.
- Viral infections, such as respiratory viruses, can also cause AOM, and may lead to secondary bacterial infections 1.
- Risk factors for AOM include young age, male sex, Native American or Eskimo ethnicity, and attendance in day care 1.
Complications and Treatment
- Complications of AOM can include hearing loss, perforation of the tympanic membrane, and suppurative sequelae like mastoiditis and intracranial complications 1.
- Treatment of AOM typically involves symptomatic management of ear pain and fever, with antibiotics reserved for children with severe, persistent, or recurrent infections 1.
- The choice of antibiotic therapy depends on the suspected causative organism and local resistance patterns, with amoxicillin-clavulanate and cefuroxime being commonly recommended options 1.
From the Research
Definition and Diagnosis of Acute Otitis Media (AOM)
- Acute otitis media (AOM) is the most common diagnosis in childhood acute sick visits, with 50% to 85% of children experiencing at least one episode by three years of age 2.
- Symptoms of AOM may include ear pain, fever, irritability, otorrhea, anorexia, and sometimes vomiting or lethargy 2.
- AOM is diagnosed in symptomatic children with moderate to severe bulging of the tympanic membrane or new-onset otorrhea not caused by acute otitis externa, and in children with mild bulging and either recent-onset ear pain or intense erythema of the tympanic membrane 2.
- The pneumatic otoscope is the standard tool used to diagnose otitis media, and clinicians should develop proficiency in distinguishing a normal tympanic membrane from otitis media with effusion or AOM 3.
Epidemiology and Burden of AOM
- AOM is a very common problem affecting the majority of children at least once and places a large burden on health care systems throughout the world 4.
- The incidence of AOM has increased during the past 25 years, probably due to an increased utilization of day care facilities in the United States 5.
Management and Treatment of AOM
- Treatment of AOM includes pain management plus observation or antibiotics, depending on the patient's age, severity of symptoms, and whether the AOM is unilateral or bilateral 2.
- High-dose amoxicillin (80 to 90 mg per kg per day in two divided doses) is first-line therapy unless the patient has taken amoxicillin for AOM in the previous 30 days or has concomitant purulent conjunctivitis 2.
- Cefdinir or azithromycin should be the first-line antibiotic in those with penicillin allergy based on risk of cephalosporin allergy 2.
- Tympanostomy tubes should be considered in children with three or more episodes of AOM within six months or four episodes within one year with one episode in the preceding six months 2.
- The pneumococcal conjugate vaccine and influenza vaccines, as well as exclusive breastfeeding until at least six months of age, can reduce the risk of AOM 2, 5.