Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ 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. ++Table Graphic Jump Location|Download (.pdf)|PrintAgeDiagnosis of AOM is CertainDiagnosis of AOM is Uncertain<6 moStart antibiotic treatmentStart antibiotic treatment6–24 moStart antibiotic treatmentObserve with follow-up assured if the patient's condition is non-severe (temperature <39°C [102.2°F] and mild otalgia);Start antibiotics if the patient's condition is severe (moderate to severe otalgia and temperature >39°C)≥24 moObserve with follow-up assured if the patient's condition is non-severe (temperature <39°C [102.2°F] and mild otalgia);Start antibiotics if the patient's condition is severe (moderate to severe otalgia and temperature >39°C)Observe with follow-up assured ++Table Graphic Jump Location|Download (.pdf)|PrintTemperature >39°C (102.2°F)Initial antibiotic choiceTreatment failure at 48–72 h after initial managementNoAmoxicillin, 80–90 mg/kg/day(If penicillin allergic: Non–type I: cefdinir, cefuroxime, or cefpodoxime; type I: azithromycin, clarithromycin)Amoxicillin–clavulanate, 90 mg/kg/day of amoxicillin with 6.4 mg/kg/ day of clavulanate(If penicillin allergic: Non–type I: ceftriaxone for 3 days; type I: clindamycin)YesAmoxicillin–clavulanate, 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate(If penicillin allergic, ceftriaxone for 3 days)Ceftriaxone for 3 days(If penicillin allergic, tympanocentesis, clindamycin)++ Single high-dose azithromycin (30 mg/kg/dose) is equal to amoxicillin in efficacy (PIDJ 2005;24:153). Add topical agents as well for AOM with perforation or if the patient has tympanostomy tubes (eg, Ciprofloxacin; Ofloxacin).Surgical treatment: Consider ENT referral if the patient has >3 episodes in 6 mo or >4 episodes in 1 yr.Complications: Labyrinthitis, mastoiditis, intracranial extension, conductive hearing loss. ++ Epidemiology: Highest incidence <2 yo; 80% of <10 yo have had one episode of omePathophysiology: Eustachian tube dysfunction: Resolution of AOM → OME (45% at 1 mo after and 10% at 3 mo after AOM); GER; anatomic (children with cleft palate)Etiologic agents: Viruses > H. influenzae > Moraxella spp., bottle feeding, feeding supine, daycare attendance, allergies, smoke exposureDiagnosisOften OME is subjectively asymptomatic → no intervention ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth