What are the discharge criteria from Ear, Nose, and Throat (ENT) clinic follow-up for Acute Otitis Media (AOM)?

From the Guidelines

Patients with acute otitis media (AOM) can be discharged from ENT clinic follow-up when they demonstrate complete resolution of symptoms, normal tympanic membrane appearance, and restored hearing, typically after 4-6 weeks of follow-up, as there is little scientific evidence for a routine 10- to 14-day reevaluation visit for all children with an episode of AOM 1.

Discharge Criteria

The discharge criteria for AOM patients include:

• Absence of ear pain, fever, and drainage
• Normal or near-normal tympanic membrane appearance without bulging, redness, or effusion
• Restored hearing function
• No recurrence of symptoms for at least 2-4 weeks
• Completion of the full course of antibiotics, if prescribed, such as amoxicillin (standard dose: 80-90 mg/kg/day divided twice daily for 5-10 days depending on severity)

Follow-up and Education

For recurrent cases (3 episodes in 6 months or 4 in 12 months), longer follow-up may be necessary before discharge 1. Patients and parents should be educated about warning signs that would necessitate return to care, including persistent ear pain, new drainage, hearing loss, or recurrent fever. This approach ensures that the middle ear infection has fully resolved and that any temporary hearing loss due to middle ear effusion has improved, preventing potential complications like chronic otitis media or conductive hearing loss.

Special Considerations

It is essential to differentiate clinically between AOM and otitis media with effusion (OME), as OME requires infrequent additional monitoring but not antibiotic therapy 1. Assurance that OME resolves is particularly important for parents of children with cognitive or developmental delays that may be affected adversely by transient hearing loss associated with middle ear effusion.

Tympanostomy Tubes

For children with recurrent AOM or chronic OME, tympanostomy tube insertion may be considered, especially if they have documented hearing difficulties or symptoms attributable to OME 1. However, the decision to insert tympanostomy tubes should be based on individual patient needs and risk factors, taking into account the potential benefits and harms of the procedure.

From the Research

Discharge Criteria from ENT Clinic Follow-up for Acute Otitis Media

The discharge criteria from ENT clinic follow-up for acute otitis media (AOM) can be determined based on the resolution of symptoms and the absence of complications.

• Parental impression of resolved ear infection and the absence of symptoms at follow-up can identify 97.1% of children with resolved AOM 2.
• Children with persistent symptoms, such as otorrhea, or those at higher risk for AOM, such as those under 15 months or with a family history of recurrent AOM, may require continued follow-up 2.
• The presence of complications, such as facial paralysis, may require more intensive treatment and follow-up 3, 4.
• The use of antibiotics, such as amoxicillin, may be indicated in cases of AOM with severe symptoms or in children with a high risk of complications 5, 6.
• Tympanostomy tubes may be considered in children with recurrent AOM or persistent symptoms 6.

Factors Associated with Discharge from ENT Clinic Follow-up

Several factors can be associated with discharge from ENT clinic follow-up for AOM, including:

• Resolution of symptoms, such as ear pain and fever
• Absence of complications, such as facial paralysis or mastoiditis
• Age of the child, with younger children requiring more frequent follow-up
• Family history of recurrent AOM
• Presence of underlying medical conditions, such as immunodeficiency

Treatment and Follow-up

Treatment and follow-up for AOM can vary depending on the severity of symptoms and the presence of complications.

• Antibiotics, such as amoxicillin, may be prescribed for children with severe symptoms or those at high risk of complications 5, 6.
• Pain management, such as acetaminophen or ibuprofen, may be recommended for children with ear pain or fever 6.
• Follow-up appointments may be scheduled to monitor the resolution of symptoms and the absence of complications 2, 3.