Treatment

• 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.

Uncomplicated AOM is self-limiting in most children (∼ 80%)

• Outpatient observation and surveillance of symptoms for 48–72 hours

• Oral analgesia

  • Acetaminophen

  • Ibuprofen

• No sufficient evidence to support the routine use of opioids, decongestants, antihistamines, steroids

Many patients with AOM can be treated conservatively

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.

• Children [2][8]

  • Age ≤ 6 months

  • Age < 2 years with bilateral AOM

  • Any age with:

    • Symptoms that have not improved after 48–72 hours

    • Severe AOM

    • 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

• Not routinely indicated in acute AOM

• Consider for patients with treatment failure or recurrent infection.

• Myringotomy

  • 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

• 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

• 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