Otitis Media

Amina Lalani

Introduction

Otitis media is an inflammatory process in the middle ear cavity
One of the most frequent infections in childhood
Most frequent reason for antibiotics in developed countries
Very common in children in daycare
Peak incidence 6-12 months age when infants have lost maternal antibodies
Typical pathogens: Streptococcus pneumoniae, Moraxella catarrhalis, nontypable Haemophilus influenzae

Clinical Practice Guidelines

Revised American Academy of Pediatrics guidelines (2004)
Include delaying treatment of otitis media in specific cases due to concerns about increasing antibiotic resistance
Rate of penicillin-resistant S. pneumoniae up to 12-14% in Canada
Need to know local rates of resistance
AAP recommendations to observe children with acute uncomplicated OM are controversial
Three different meta-analyses showed up to 80% of children recover without antibiotics, but may have included children with otitis media with effusion

Table 14.1 Risk Factors for Antibiotic Resistance

PENICILLIN RESISTANCE	MACROLIDE RESISTANCE
Daycare	Previous antibiotics
Antibiotics in preceding month	Age < 5 yrs
Age < 3 yrs	Nosocomial infection
	Penicillin resistance

Table 14.2 Otitis Media Subtypes

Acute otitis media	Diagnosis requires all three signs:
	Acute onset of signs and symptoms of middle ear effusion and inflammation Presence of middle ear effusion indicated by: Bulging of the tympanic membrane Limited or absent mobility of the tympanic membrane Air fluid level behind the tympanic membrane Otorrhea Signs and symptoms of middle ear inflammation indicated by: Erythema of the tympanic membrane OR Otalgia (interferes/prevents normal activity or sleep)
	Middle ear effusion with constitutional signs of illness is not sufficient for a diagnosis of AOM.
	In case of doubt, wait and reassess.
Otitis media with effusion	Presence of middle ear effusion without signs or symptoms of acute infection Very common after an episode of otitis media Usually no pain or fever May be difficult to differentiate from acute OM
Chronic otitis media	Infection persists > 2-3 weeks