AAO-HNSF Primary Care Otolaryngology Handbook

CHAPTER 4

Otitis Media

Clinical Practice Guideline: Acute Otitis Externa Clinical Consensus Statement: Balloon Dilation of the Eustachian Tube

Otitis media may simply be defined as inflammation of the middle ear space , the space between the eardrum and the inner ear. Otitis media is the second-most common disease diagnosed in young children. Otitis media can be classified by duration, patient symptoms, and physical exam findings. It is important for the clinician to be familiar with two common variants of otitis media: (1) acute otitis media and (2) otitis media with effusion . Children with acute otitis media frequently present with sudden onset of fever, ear pain, and fussiness. In patients with acute otitis media, the eardrum is bulging and yellow or white in color with dilated vessels, and there is decreased movement of the eardrum on pneumatic otoscopy (insufflation of air into the ear canal) (Figure 4.1). Common bacteria that cause acute otitis media in children are Streptococcus pneumoniae, Haemophilus influenzae , and Moraxella catarrhalis . In healthy children older than 2 years of age who present with less severe symptoms (mild

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otalgia for less than 48 hours and tempera- ture lower than 39°C [102.2°F]), observa- tion for 48 hours may be considered. If the decision is made to treat with anti- bacterial agents, amoxicillin dosed at 80–90 mg/kg per day is the first-line anti- biotic therapy . Azithromycin can be used to treat patients who have a penicillin allergy. The high incidence of resistant organisms can make the treatment of acute otitis media challenging. For example, in patients who do not respond to first-line antibiotic therapy, a beta-lactamase- producing organism or a resistant Streptococcus organismmay be responsible

Figure 4.1. This tympanic membrane (TM) demonstrates the bulging seen with an acute infection.

Primary Care Otolaryngology