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Otitis media: diagnosis and treatment
Kathryn M Harmes1, R Alexander Blackwood, Heather L Burrows
1University of Michigan, Ann Arbor, MI, USA.
Abstract:
Acute otitis media is diagnosed in patients with acute onset, presence of middle ear effusion, physical evidence of middle ear inflammation, and symptoms such as pain, irritability, or fever. Acute otitis media is usually a complication of eustachian tube dysfunction that occurs during a viral upper respiratory tract infection. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common organisms isolated from middle ear fluid. Management of acute otitis media should begin with adequate analgesia. Antibiotic therapy can be deferred in children two years or older with mild symptoms. High-dose amoxicillin (80 to 90 mg per kg per day) is the antibiotic of choice for treating acute otitis media in patients who are not allergic to penicillin. Children with persistent symptoms despite 48 to 72 hours of antibiotic therapy should be reexamined, and a second-line agent, such as amoxicillin/clavulanate, should be used if appropriate. Otitis media with effusion is defined as middle ear effusion in the absence of acute symptoms. Antibiotics, decongestants, or nasal steroids do not hasten the clearance of middle ear fluid and are not recommended. Children with evidence of anatomic damage, hearing loss, or language delay should be referred to an otolaryngologist.
Insights
Acute otitis media (AOM) is an ear infection diagnosed by acute onset, middle ear effusion, and inflammation. Management includes analgesia, with antibiotics reserved for specific cases, and amoxicillin as the first choice.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Microbiology
Background:
- Acute otitis media (AOM) commonly follows viral upper respiratory infections, leading to eustachian tube dysfunction.
- Key pathogens include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
- Diagnosis relies on acute onset, middle ear effusion, and physical signs of inflammation.
Purpose of the Study:
- To outline diagnostic criteria for acute otitis media.
- To detail recommended management strategies for AOM.
- To differentiate AOM from otitis media with effusion (OME).
Main Methods:
- Clinical diagnosis based on patient symptoms (pain, fever, irritability) and physical examination findings.
- Microbiological analysis of middle ear fluid to identify causative organisms.
- Treatment guidelines based on patient age, symptom severity, and response to therapy.
Main Results:
- Amoxicillin (80-90 mg/kg/day) is the preferred antibiotic for penicillin-allergic patients.
- Antibiotic therapy can be delayed in children over two years with mild symptoms.
- Amoxicillin/clavulanate is a suitable second-line option for persistent symptoms.
Conclusions:
- Prompt analgesia is crucial for AOM symptom management.
- Otitis media with effusion (OME) requires no antibiotic treatment.
- Referral to an otolaryngologist is recommended for children with complications like hearing loss or language delay.
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