Otitis Media

Definition
Inflammation of the middle ear – AOM may progress to OME following clearing of infection. Peak incidence between 6mo-12mo; more common in fall and winter.

Organisms

  • Streptococcus pneumoniae
  • Hemophilus influenzae
  • Moraxella catarrhalis
  • GAS, S. aureus, pseudomonas

Pathophysiology
Eustachian tube dysfunction (shorter, more compliant and horizontal in younger children)

Complications

  • Hearing loss (spread in infection into labyrinth – sensorineural loss)
  • TM perforation
  • Chronic suppurative otitis media
  • Tympanosclerosis
  • Cholesteatoma
  • Acute mastoiditis
  • Facial nerve paralysis
  • Bacterial meningitis

History

  • Current episode with symptoms (pain, fever, discharge)
  • Recent treatment with antibiotics
  • Past medical history (Down, cleft palate, previous episodes)
  • Exposure to large number of children
  • Smoking
  • Formula vs breast fed

Physical exam

  • Look for other causes of fever and irritability (URTI, pharyngitis, lymphadenitis, meningitis, UTI, bone/joint infections)
  • Conjuctivitis + AOM suggests H. influenzae infection
  • Otoscopy (cerumen must be removed)
    • TM characteristics
      • Contour: normal, retracted, full, bulging
      • Color: grey, pink, yellow, white, red
      • Translucency: translucent, opaque
      • Mobility: normal, decreased or absent

Management
As many infections will resolve on their own, and with growing numbers of resistant organisms, antibiotics are not necessary in all cases. However, in Canada the gold standard remains to treat with antibiotics. Amoxicillin x 10days remains the antibiotic of first choice, although a higher dosage (80 mg per kg per day) may be indicated to ensure eradication of resistant Streptococcus pneumoniae. 2nd line – Bactrim (TMP-SMZ).

Prophylaxis

  • If child has >3 episodes in 6 months or >4 episodes in 1 year
  • Amoxicillin 25mg/kg daily for 6 months or until next warm season
  • Consult ENT for tubes or adenoidectomy if ongoing infections

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