RT Book, Section
A1 Lowry, Adam W.
A1 Bhakta, Kushal Y.
A1 Nag, Pratip K.
SR Print(0)
ID 7436216
T1 Chapter 12. Ear, Nose, and Throat
T2 Texas Children's Hospital Handbook of Pediatrics and Neonatology
YR 2011
FD 2011
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-163924-8
LK accesspediatrics.mhmedical.com/content.aspx?aid=7436216
RD 2024/04/19
AB Epidemiology:  33%  of  all  pediatric  office  visits;  by  3  yo,  80%  have  ≥  1  AOMPathophysiology:  URI  or  inflammation  →  Eustachian  tube  dysfunction  or  occlusion  →  effusion  →  infectionEtiologic  agents:  Respiratory  viruses  >>  Haemophilus  influenzae  (Post  PCV7  52%,  Pre  PCV7  15-30%)  >  Pneumococcus  spp.  (Post  PCV7  34%,  Pre  PCV7  25-50%)  >  Moraxella  spp.  (Pre  PCV7  3%–20%)  >  GABHS  >  other  (Pediatrics  2004;113:1451)DiagnosisHistory:  Fever  (especially  increasing  fever  curve),  URI,  ear  pain  or  fullness,  hearing  loss,  vomiting,  ear  drainage  or  diarrhea.Physical  exam:  Bulging  tympanic  membrane  (TM),  purulent  material,  air-fluid  level,  ↓  or  no  movement  of  TM,  otorrhea,  ±  redness,  ±  bullae.Best  predictors  are  position  (ie,  bulging),  mobility  of  TM  (↓  or  no  movement  of  TM),  and  color  (PIDJ  1998;17(6):540).  Consider  tympanocentesis  and  bacterial  culture  for  children  with  recurrent  or  chronic  disease.TreatmentPain  and  fever  control  are  the  most  important  interventions.Within  24  hours,  61%  of  patients  have  resolution  of  symptoms  without  antibiotics.Antibiotics  (see  table  below)  often  do  not  change  the  duration  of  illness  of  AOM.