What is a common ear infection in adolescents, specifically Otitis Media (Middle Ear Infection)?

From the Guidelines

Otitis media, specifically acute otitis media (AOM), is a common ear infection in adolescents, characterized by inflammation of the middle ear, typically caused by bacteria or viruses, and symptoms include ear pain, reduced hearing, and fever. According to the study published in Nature Reviews Disease Primers 1, otitis media is a spectrum of diseases, including AOM, otitis media with effusion (OME), and chronic suppurative otitis media (CSOM). The study highlights that OM is among the most common diseases in young children worldwide, and although it may resolve spontaneously without complications, it can be associated with hearing loss and life-long sequelae.

Some key points to consider in the management of otitis media in adolescents include:

• The role of symptomatic management of ear pain and fever as the mainstay of AOM treatment, reserving antibiotics for children with severe, persistent, or recurrent infections 1
• The use of diagnostic modalities such as (pneumatic) otoscopy, tympanometry, and audiometry to diagnose OM 1
• The potential for hearing loss and developmental delays in children with OME, and the need for watchful waiting and possible insertion of ventilation tubes or adenoidectomy in severe cases 1
• The importance of preventing recurrences of AOM through measures such as pneumococcal conjugate vaccination and judicious use of antibiotics 1

In terms of treatment, antibiotics such as amoxicillin may be prescribed for bacterial infections, and over-the-counter medications such as acetaminophen or ibuprofen can be used for pain management. However, it is essential to follow up with a healthcare provider if symptoms persist beyond 48-72 hours of antibiotic treatment or if there are recurrent infections. The study also highlights the need for further research on the role of hearing aids in alleviating symptoms of hearing loss in the management of OME 1.

From the FDA Drug Label

Acute otitis media caused by Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae.

A common ear infection in adolescents is Otitis Media (Middle Ear Infection), which can be caused by:

• Haemophilus influenzae
• Moraxella catarrhalis
• Streptococcus pneumoniae 2

From the Research

Definition and Diagnosis of Otitis Media

• Otitis Media, also known as Middle Ear Infection, is a common ear infection in adolescents, characterized by symptoms such as ear pain, fever, irritability, otorrhea, anorexia, and sometimes vomiting or lethargy 3.
• Diagnosis is typically made 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 3.

Treatment Options for Otitis Media

• Treatment includes pain management plus observation or antibiotics, depending on the patient's age, severity of symptoms, and whether the Otitis Media is unilateral or bilateral 3.
• Amoxicillin is the first-line drug for Otitis Media, with effective second-line drugs including trimethoprim-sulfamethoxazole, erythromycin-sulfisoxazole, cefaclor, cefuroxime axetil, and cefixime 4.
• 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 Otitis Media in the previous 30 days or has concomitant purulent conjunctivitis; amoxicillin/clavulanate is typically used in this case 3.

Antibiotic Treatment Duration and Efficacy

• Short-course antibiotics (less than seven days) may be less effective than long-course antibiotics (seven days or more) in treating Otitis Media, with a higher risk of treatment failure 5.
• However, short-course antibiotics may also reduce the risk of gastrointestinal adverse events 5.
• Amoxicillin treatment for Otitis Media has been shown to be effective, with treatment failure uncommon and not differing by pathogen or beta-lactamase production 6.

Prevention and Risk Reduction

• Pneumococcal and influenza vaccines and exclusive breastfeeding until at least six months of age can reduce the risk of Otitis Media 3.
• Tympanostomy tubes should be considered in children with three or more episodes of Otitis Media within six months or four episodes within one year with one episode in the preceding six months 3.