Acute Otitis Media

Question 1

Acute Otitis Media Definition

Answer 1

Rapid, acute onset of signs and symptoms of inflammation in the middle ear

Question 2

Otorrhea definition

Answer 2

Discharge/drainage from the ear; can originate from one or more sites within the ear

Question 3

Otalgia definition

Answer 3

Ear ache or ear pain

Question 4

Uncomplicated AOM

Answer 4

AOM without otorrhea

Question 5

Non-severe AOM

Answer 5

AOM with the presence of mild otalgia AND temperature < 39C

Question 6

Severe AOM

Answer 6

AOM with the presence of moderate to severe otalgia OR fever > 39

Question 7

Recurrent AOM

Answer 7

3 or more well-documented and separate occasions of AOM in the preceding 6 months OR
4 or more episodes in the preceding 12 months with at least 1 episode in the last 6 months

Question 8

Population most affected by AOM

Answer 8

Age 6-24 months, peak between 6 to 12 months
More common in males compared to females

Question 9

Pathophysiology of AOM

Answer 9

An inflammatory process that typically follows a URI
Leads to obstruction of the Eustachian tube and causes buildup of mucosal secretions in middle ear allowing bacterial or viral colonization

Question 10

Causes of viral AOM

Answer 10

RSV
Coronaviruses
Influenza viruses
Adenoviruses
Human metapneumoviruses
Picornaviruses

Question 11

Causes of bacterial AOM

Answer 11

S. pneumoniae
H. influenzae
Moraxella catarrhalis

Question 12

Risk factors of AOM

Answer 12

Genetic predisposition
Family hx of recurrent AOM
Allergies
Lack of breastfeeding
Low socioeconomic status
Passive smoke exposure
Daycare attendance
Pacifier use
Winter season

Question 13

Signs and symptoms of AOM

Answer 13

Otalgia (pulling/tugging at the ears)
Irritability
Headache
Disturbed or restless sleep
Poor feeding
Vomiting/diarrhea
Fever

Question 14

Diagnosis of AOM

Answer 14

Moderate to severe bulging of the tympanic membrane OR
New onset of otorrhea not caused by otitis externa OR
Mild tympanic membrane bulging with recent onset of ear pain or erythema

Question 15

Treatment of otorrhea with AOM

Answer 15

Antibiotic therapy

Question 16

Treatment of unilateral or bilateral AOM with severe symptoms

Answer 16

Antibiotic therapy

Question 17

Treatment of bilateral AOM without otorrhea

Answer 17

6 mo to 2 y: Antibiotic therapy
>/= 2 y: antibiotic therapy or additional observation

Question 18

Treatment of unilateral AOM without otorrhea

Answer 18

Antibiotic therapy or additional observation

Question 19

What is “watchful waiting”

Answer 19

Most common treatment recommendation for patients >/= 2 years presenting with mild symptoms
May be considered for patients 6 mos to 2 yrs if presenting with unilateral AOM without otorrhea
Antibiotics may be started after 48-72 hours if symptoms are worsening or persistent

Question 20

Antibiotics used for AOM (1st line and alternative)

Answer 20

1st line:
Amoxicillin (80-90 mg/kg/day divided in 2 doses)
Augmentin (90 mg/kg/day of amoxicillin and 6.4 mg/kg/day of clavulanate divided in 2 doses)

Alternative (PCN allergy)
Cefdinir (14 mg/kg/day in 1-2 doses)
Cefuroxime (30 mg/kg/day in 2 divided doses)
Cefpodoxime (10 mg/kg/day in 2 divided doses)
Ceftriaxone ( 50 mg IM or IV per day for 1 or 3 days)

Question 21

Duration of treatment for AOM

Answer 21

</= 2 years: 10 days of amoxicillin
>2 years: 5 to 7 days

Question 22

Pain management in AOM

Answer 22

Ibuprofen (>/= 6 months): 5-10 mg/kg/dose q6h prn
Acetaminophen: 10-15 mg/kg/dose q4-6h prn

Question 23

When are tympanostomy tubes recommended and advantages/disadvantages

Answer 23

Patients with recurrent AOM
Advantages: Can decrease AOM episodes, can restore hearing, can relieve pain and irritability
Disadvantages: Can scar the tympanic membrane, child must be put under general anesthesia for the procedure