Middle Ear Infection
- Day care attendance.
- Presence of siblings in the home.
- Family history of recurrent otitis media.
- Premature birth.
- Male gender.
- Presence of anatomical defects associated with Down’s syndrome or cleft palate.
- Immunodeficiency syndromes.
- Exposure to smoking.
- To diagnose AOM, there should be a history of acute onset of ear pain or irritability, signs of fluid in the middle ear space, and signs of middle ear inflammation.
- Observation without the use of antibiotics for 48 to 72 hours in selected cases is an acceptable option. This option is based on the fact that numerous studies have shown that most children do well, without adverse outcome, even without antibacterial therapy.
- If a decision is made to treat with an antibiotic, the clinician should prescribe amoxicillin for most children. Numerous studies have shown that the most common bacterial pathogens in AOM are Streptococcus pneumoniae, nontypeable H. influenzae, and M. catarrhalis. High dose amoxicillin (Amoxil) is the best choice for S. pneumoniae, which is less likely to spontaneously resolve and potentially more serious than the later two.
- If the patient fails to respond to the initial management option within 48 to 72 hours, the clinician must reassess the patient to confirm AOM and exclude other causes of illness. If the patient has already been started on an antibiotic, then it should be changed to a second or third line antibiotic.
- For those patients with mild sensitivity to amoxicillin, acceptable alternatives include cefdinir (Omnicef), cefpodoxime (Cefzil), or cefuroxime (Ceftin). These agents, along with amoxicillin-clavulanate (Augmentin), are also commonly used as second or third line therapy. For those patients with more severe sensitivity to amoxicillin, alternatives include azithromycin (Zithromax) or other macrolides.
- In those cases where a child is unable to take oral medicine due to vomiting, or in cases of ongoing severe infection despite multiple courses of oral antibiotics, injected ceftriaxone (Rocephin) may be used.
- When possible, clinicians should encourage the prevention of AOM through the reduction of risk factors. Examples would include limiting day care attendance and breast feeding for the first 6 months to provide passive immunity. There has been a modest reduction of cases since the introduction of pneumococcal vaccine (Prevnar).
- To date there are no studies that conclusively show a beneficial effect of alternative medicine therapies, steroids, or antihistamines in the treatment of otitis media.
- A child who has had fluid in both middle ears for a total of 3 months should undergo hearing evaluation. Before 3 months of effusion, hearing evaluation is an option.
- For a child who has had bilateral effusion for a total of 3 months and who has a bilateral hearing deficiency (defined as a 20 decibel loss in the better hearing ear), insertion of tympanostomy tubes becomes an additional treatment option. Placement of tympanostomy tubes is recommended after a total of 4 to 6 months of middle ear fluid in both sides and hearing loss on both sides.
- Adenoidectomy is not an appropriate treatment for uncomplicated OME in the child younger than 4 years when adenoid pathology is not present.
- Tonsillectomy, either alone or with adenoidectomy, has not been found effective for treating OME.
- These recommendations are tempered by the fact that there is little research to support the theory that untreated OME results in speech/language delays or deficits.
Use the secure online bill pay feature to make payments 24/7!
Use the portal to securely manage personal information and more!
We have made some of our forms available online to save you time.
Listed here are helpful links that we hope you find resourceful.
Our office hours include Saturday walk-in hours from 9am - 11:30am for your convenience.