Diagnosis criteria
- AOM: bulging, inflamed eardrum OR acute inflammation and decreased mobility on pneumatoscopy (symptoms: fever, pain, irritability)
- Myringitis: normal mobility on pneumatoscopy with peripheral redness
- OME: visible fluid or reduced mobility on pneumatoscopy without acute inflammation
Etiology
- S. pneumoniae (40%), H. influenzae (25%), M. catarrhalis (10%), GAS (2%), S. aureus (2%)
Complications
- Hearing loss
- TM perforation
- Chronic suppurative otitis media
- Tympanosclerosis
- Cholesteatoma
- Acute mastoiditis
- Facial nerve paralysis
- Bacterial meningitis
Treatment
- Amoxicillin 40mg/kg/day PO divided tid x 5 days
- Azithromycin 10mg/kg/day 1st day, then 5mg/kg/day x 4 days
- Treat for longer (10d) at a higher dose (90mg/kg/day) if pt has received abics in last 3 months, attends daycare, or has recurrent disease.
- Antibiotics prophylaxis is not recommended
Indications for ENT referral (tympanostomy)
- OME for ≥2 months with bilateral hearing loss ≥20dB
- ≥3 episodes in 6 months
- ≥4 episodes in 12 months
- Retracted tympanic membrane