How to generally treat AOM?
Screen patients for acute complications such as mastoiditis and labyrinthitis and treat if present.
Provide analgesia as needed.
Consider antibiotic therapy based on the patient's age and clinical features.
Children < 2 years of age: Generally give antibiotics.
Children ≥ 2 years of age
Severe symptoms and/or otorrhea: Give antibiotics.
Mild symptoms and no otorrhea: conservative management
Adults: Antibiotics are typically given
Reassess all patients managed conservatively after 48–72 hours; if there is no improvement, give antibiotics.
Consult ENT for adults with recurrent AOM or persistent otitis media with effusion.
When and how to perform conservative management?
Uncomplicated AOM is self-limiting in most children (∼ 80%)
Outpatient observation and surveillance of symptoms for 48–72 hours
No sufficient evidence to support the routine use of opioids, decongestants, antihistamines, steroids
Many patients with AOM can be treated conservatively
Refer to the antibiotic treatment of AOM
Systemic antibiotic therapy in AOM is recommended to relieve symptoms and reduce the risk of complications in young infants and patients with severe infections
Topical antibiotics are typically reserved for patients with AOM and tympanostomy tubes or those with chronic suppurative otitis media.
Treatment failure is common (due to drug resistance and viral coinfection); If initial treatment is unsuccessful, consider tympanocentesis to help guide further therapy.
Typical duration of first-line therapy
Children < 2 years OR any child with severe symptoms: 10 days
Children ≥ 2 years AND no severe symptoms: 5–7 days
Topical antibiotics are generally ineffective in treating AOM unless tympanostomy tubes are present.
What are indications for antibiotic treatment?
Age ≤ 6 months
Age < 2 years with bilateral AOM
Any age with:
Symptoms that have not improved after 48–72 hours
Signs of severe systemic illness
Otorrhea not due to otitis externa
Cochlear implants (Children with cochlear implants who develop AOM should always be treated with antibiotics)
Adults: Antibiotics (e.g., amoxicillin) are typically given to prevent complications
Name indications for surgical procedures
Not routinely indicated in acute AOM
Consider for patients with treatment failure or recurrent infection.
Explain the types of surgical procedures that can be performed
Surgical incision into the tympanic membrane to drain fluid to relieve pressure/pain
Consider as an adjunct to antibiotic therapy for severe otalgia and a bulging tympanic membrane
Myringotomy with tympanostomy tube insertion
Placement of small tubes into the tympanic membrane to prevent the accumulation of fluid
Consider for chronic otitis media and in children with recurrent AOM
How to manage AOM with perforated tympanic membrane?
Usually (> 90%) heals spontaneously with systemic antibiotic therapy
There is no added advantage of topical antibiotics for AOM with TM perforation unless tympanostomy tubes are present
The ear should be kept clean and dry until the TM has fully healed
How to treat patients with tympanostomy tubes?
Increased discharge indicates acute infection.
Usually caused by the same spectrum of bacterial pathogens, but Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermis are also possible
Can be treated with topical antibiotics for 7 days (e.g., ofloxacin, ciprofloxacin/dexamethasone
If there are complications or systemic illness, oral antibiotics (normally amoxicillin/clavulanic acid) can be given