Primary Care Otolaryngology

Chapter 5

of resistant organisms in your community, a common second-line therapy for acute otitis media is high-dose amoxicillin-clavulanate.

Breastfeeding and vaccination with a pneumococcal conjugate preparation may decrease the incidence of acute otitis media in children, while other factors, such as daycare attendance, young siblings at home, and exposure to tobacco smoke, may predispose chil- dren to develop otitis media. Some chil- dren develop recurrent acute otitis media, or recurring acute, symptomatic ear infections . Such children may ben- efit from pressure equalization (PE) 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.

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Figure 5.2. Photograph of a tympanic membrane with a pressure equalizing (PE) tube in place. The tube permits aeration of the middle ear space.

Insertion of PE tubes involves placing small tubes in the eardrum to venti- late the middle ear and prevent the negative pressure and fluid buildup. In a child with an open PE tube, ear drainage typically indicates an ear infec- tion. An advantage of PE tubes is the ability to treat episodes of ear drain- age with topical antibiotic therapy, such as fluoroquinolone ototopical drops applied to the ear canal. Currently, there is a trend to use fluoroqui- nolone drops rather than traditional neomycin/polymyxin B/hydrocorti- sone preparations, due to the theoretical risk of ototoxicity associated with these medications. The PE tubes generally extrude on their own after one to two years. In the past, antibiotic prophylaxis for a three- to six-month trial was an alternative treatment for children with recurrent acute otitis media. Due to concern over the development of resistant organisms, the routine use of antibiotic prophylaxis for recurrent acute otitis media in otherwise healthy children has been largely abandoned. OME, or middle ear fluid without active infection, may occur after treat- ment of an acute episode of otitis media, or due to chronic eustachian tube dysfunction. While the majority of children will clear middle ear fluid within three months of an acute ear infection, those with eustachian tube dysfunction may have problems with persistent middle ear fluid. Children with OME are often asymptomatic, although they may complain of ear fullness or muffled hearing. These patients do not have the fevers, irritabil- ity, and ear pain that are associated with acute otitis media. On physical

Primary Care Otolaryngology