AAO-HNSF Primary Care Otolaryngology Handbook

OTITIS MEDIA

for treatment failure. While treatment choices in such patients will be dictated by the prevalence of resistant organisms in your community, a common second-line treatment for acute otitis media is high-dose amoxicillin-clavulanate. Breastfeeding and vaccination with a pneumococcal conjugate prepara- tion may decrease the incidence of acute otitis media in children, while other factors, such as daycare attendance and exposure to tobacco smoke, may predispose children to develop otitis media. Some children develop recurrent acute otitis media , or recurring acute, symptomatic ear infections. These children may benefit from myringotomy tube , or ear tube, insertion if they have three to four bouts of acute otitis media in six months or five to six bouts in a single year. Insertion of ear tubes involves placing small tubes in the eardrum to ventilate the middle ear and prevent negative pressure and fluid buildup (Figure 4.2). Ear tube placement is a short procedure that is often performed on an outpatient basis. Water precautions, such as the use of

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ear plugs for swimming and bathing, are not routinely required in children with ear tubes. The ear tubes generally extrude on their own after one to two years. In a child with an open ear tube, ear drainage, either purulent or bloody, typically indicates an ear infection. An advantage of ear tubes is the ability to treat episodes of ear drainage or otor- rhea with topical antibiotic therapy (e.g., fluoroquinolone ototopical drops) applied directly to the ear canal. Currently, there is a trend to use fluoro- quinolone drops rather than traditional neomycin/polymyxin B/hydrocortisone preparations, because of the theoretical risk of ototoxicity associated with the latter medication.

Figure 4.2. Photograph of a TM with a pressure equalizing (PE) tube in place. The tube permits aeration of the middle ear.

Oral antibiotics are not indicated as first-line therapy for children with ear tubes who present with uncomplicated otorrhea. In the past, antibiotic prophylaxis for a three- to six-month trial was an alternative treatment for children with recurrent acute otitis media. Because of concern about the development of resistant organisms, the routine use of antibiotic prophy- laxis for recurrent acute otitis media in otherwise healthy children has been largely abandoned.

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