What is the recommended follow-up schedule in general practice for Acute Otitis Media (AOM)?

Follow-up Schedule for Acute Otitis Media (AOM) in General Practice

For most patients with AOM, routine follow-up is not necessary if symptoms improve within 48-72 hours after treatment initiation, but reassessment is warranted for those without early improvement and if symptoms fail to resolve completely by 2 weeks.1

Initial Follow-up Assessment

• Patients with uncomplicated AOM should show symptom improvement (pain, fever, irritability) within 48-72 hours of treatment initiation 1
• If symptoms do not improve within 48-72 hours, the patient should be reassessed to:
  • Determine need for aural toilet or wicking 1
  • Reconsider the diagnosis 1
  • Reevaluate pain management 1
  • Assess adherence to therapy 1
  • Consider changing antimicrobial therapy if initially prescribed 1

Follow-up Based on Treatment Response

For Patients Who Improve:

• Once clinical improvement occurs, routine follow-up visits are not scientifically supported for all children with AOM 1
• Complete resolution of symptoms may take up to 2 weeks even with appropriate treatment 1

For Patients Who Don't Improve:

• Reassessment within 48-72 hours is recommended if:
  • Symptoms worsen at any time 1
  • No clinical improvement is observed within the initial 48-72 hours 1
  • The child is under 2 years of age with severe initial symptoms 1

Special Considerations for Follow-up

• Follow-up is particularly warranted for:
  • Young children (≤15 months) 2
  • Children with severe initial symptoms 1
  • Those with recurrent AOM 1
  • When specifically requested by parents 1
  • Children with cognitive or developmental delays who may be affected by hearing loss 1

Monitoring for Middle Ear Effusion (MEE)

• Persistent MEE is common after AOM resolution and does not require antibiotics 1
• After successful antibiotic treatment of AOM:
  • 60-70% of children have MEE at 2 weeks 1
  • 40% have MEE at 1 month 1
  • 10-25% have MEE at 3 months 1
• MEE without clinical symptoms is defined as Otitis Media with Effusion (OME) and requires only infrequent monitoring, not antibiotics 1

Parental Assessment and Follow-up Strategy

• Parental impression of resolved ear infection and absence of symptoms accurately identify 97.1% of children with resolved AOM 2
• A selective follow-up strategy may be implemented where follow-up is offered to:
  • Children whose parents feel the infection has not resolved 2
  • Children with persistent symptoms 2
  • Higher-risk children (≤15 months or with family history of recurrent otitis) 2

Treatment Failure Assessment

• If symptoms fail to resolve completely by 2 weeks, follow-up is warranted 1
• Treatment failure may be due to:
  • Obstructed ear canal 1
  • Poor adherence to therapy 1
  • Misdiagnosis 1
  • Microbiologic factors (resistant organisms) 1
  • Host factors 1
  • Contact sensitivity to eardrops 1

Pitfalls to Avoid

• Failing to reassess patients who don't improve within 48-72 hours 1
• Assuming persistent MEE requires antibiotics (it's normal and doesn't require treatment) 1
• Missing alternative causes of persistent symptoms such as:
  • Fungal infections 1
  • Dermatologic disorders affecting the ear canal 1
  • Unrecognized foreign body 1
  • Perforated tympanic membrane 1
  • Underlying middle ear disease 1

By following these guidelines for AOM follow-up, clinicians can ensure appropriate monitoring while avoiding unnecessary visits, reducing healthcare costs, and minimizing antibiotic overuse.