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Patient Story
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A 15-month-old boy is brought by both parents to his pediatrician with a 2-day history of fever, irritability, and frequent tugging of his left ear. This was preceded by a 1-week history of nasal congestion, cough, and rhinorrhea. On otoscopy, his left tympanic membrane (TM) appears erythematous, cloudy, bulging, and exudative (Figure 22-1). His left TM fails to move on pneumatic otoscopy. The physician diagnoses acute otitis media and decides with the parents to prescribe a 10-day course of amoxicillin; the child recovers uneventfully.

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FIGURE 22-1

Acute otitis media in the left ear of a 15-month-old patient with marked erythema and bulging of the tympanic membrane. The malleus and light reflex are not visible. (Used with permission from William Clark, MD.)

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In follow-up 2 months later, the child appears healthy and is meeting all his developmental milestones. On otoscopic examination, air–fluid levels are seen in the right ear (Figure 22-2). The physician explains the diagnosis of otitis media with effusion to the parents and arranges follow-up. Three months later the effusion is completely resolved.

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FIGURE 22-2

Otitis media with effusion (OME) in the right ear. Note multiple air–fluid levels in this slightly retracted, translucent, nonerythematous tympanic membrane. (Used with permission from Frank Miller, MD.)

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Introduction
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Acute otitis media (AOM) is the most common diagnosis for acute office visits for children.1 AOM is characterized by middle-ear effusion in a patient with signs and symptoms of acute illness (e.g., fever, irritability, otalgia). Otitis media with effusion (OME) is a disorder characterized by fluid in the middle ear in a patient without signs and symptoms of acute ear infection; it is also very common in childhood.

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Epidemiology
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  • AOM accounted for $5 billion of the total national health expenditure in 2000; more than 40 percent was incurred for children between 1 and 3 years of age.1

  • It is estimated that 60 percent to 80 percent of children in the US develop AOM by 1 year of age and that 80 percent to 90 percent develop AOM by 2 to 3 years of age.2,3

  • The highest incidence occurs between 6 and 24 months of age.2,3

  • AOM is the most common reason for outpatient antibiotic treatment in the US.4 A national survey in 1992 revealed that 30 percent of all antibiotics prescribed for children younger than age 18 years was for treatment of AOM.5

  • OME is diagnosed in 2.2 million children yearly in the US.6

  • Approximately 90 percent of children (80% of individual ears) have OME at some time before school age, most often between ages 6 months and 4 years....

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