Treatment of Otitis Media

Diagnosis and Treatment

• Otitis media with effusion (OME) is characterized by the presence of middle ear effusion behind an intact tympanic membrane without signs and symptoms of acute infection, according to the American Academy of Pediatrics 1
• Differentiating between acute otitis media (AOM) and OME is critical to determine appropriate treatment and avoid unnecessary antibiotic use, as stated by the Infectious Diseases Society of America 2
• The American Academy of Pediatrics recommends antibiotic therapy for specific patient populations with AOM, while OME should be managed with watchful waiting as antibiotics are not recommended for this condition 3
• Topical analgesics may be more effective than placebo at reducing ear pain within 10-30 minutes after administration, as found by the American Academy of Otolaryngology-Head and Neck Surgery 4
• Antibiotic therapy is indicated for children with severe symptoms of AOM, according to the American Academy of Pediatrics 5
• Amoxicillin-clavulanate should be used if amoxicillin treatment fails, as recommended by the American Academy of Pediatrics 3, 5
• Ceftriaxone (intramuscular) may be considered for patients who failed amoxicillin-clavulanate, according to the American Academy of Pediatrics 5
• Over-diagnosis of AOM occurs in 40-80% of patients compared to confirmation using tympanocentesis, leading to unnecessary antibiotic use, as reported by the European Society of Clinical Microbiology and Infectious Diseases 2
• Bacterial resistance is now regarded as the main reason for treatment failure in AOM, according to the European Society of Clinical Microbiology and Infectious Diseases 2
• Persistent symptoms despite appropriate antibiotic therapy may be due to combined bacterial and viral infection, as stated by the American Academy of Pediatrics 3
• In children with repeated treatment failures, tympanocentesis with culture and susceptibility testing should be considered, according to the American Academy of Pediatrics 5
• After successful antibiotic treatment of AOM, 60-70% of children have middle ear effusion at 2 weeks, decreasing to 40% at 1 month and 10-25% at 3 months, as found by the American Academy of Pediatrics 5
• The presence of middle ear effusion without clinical symptoms after AOM resolution is defined as OME and requires monitoring but not antibiotics, according to the American Academy of Pediatrics 5

Management of Otitis Media

Diagnosis and Treatment Approach

• The American Academy of Pediatrics recommends that acute otitis media (AOM) is diagnosed when there is moderate to severe bulging of the tympanic membrane or new onset of otorrhea not due to acute otitis externa, or mild bulging of the tympanic membrane with recent onset of ear pain or intense erythema 6
• The American Academy of Otolaryngology-Head and Neck Surgery suggests that pain management is paramount and should be the first step in treatment of AOM 7
• Antibiotic therapy is indicated for children younger than 6 months with AOM, children 6-23 months with bilateral AOM, children with severe symptoms, and cases with high risk of complications 8, 6, 7
• The American Academy of Pediatrics recommends watchful waiting for children ≥24 months with non-severe symptoms, and children 6-23 months with unilateral non-severe AOM, with follow-up within 48-72 hours if symptoms persist or worsen 8, 6

Otitis Media with Effusion (OME) Treatment

• The American Academy of Family Physicians recommends that watchful waiting is the recommended initial approach for most children with OME, and antibiotics, decongestants, antihistamines, and nasal steroids are not recommended as they do not hasten clearance of middle ear fluid 9
• The American Academy of Otolaryngology-Head and Neck Surgery suggests that tympanostomy tubes are indicated when OME persists for ≥3 months with documented hearing loss or underlying conditions that increase risk for developmental sequelae 7
• The American Academy of Family Physicians recommends follow-up at 3-month intervals until effusion resolves, and hearing testing if OME persists for 3 months or longer 9

Key Differences in Management

• The American Academy of Pediatrics and the American Academy of Otolaryngology-Head and Neck Surgery suggest that antibiotic use differs between AOM and OME, with antibiotics indicated in specific cases of AOM but not recommended for OME 6, 9
• The American Academy of Family Physicians recommends different follow-up timings for AOM and OME, with 48-72 hours for AOM and 3-month intervals for OME 8, 9