Pediatric Otology

Question 1

Definition of Recurrent Otitis Media

Answer 1

Three or more Episodes of well documented and separate episodes of acute otitis media in the past 6 months, OR at least four well documented and separate episodes of AOM the last 12 months with at least one episode in the last 6 months.

Question 2

Indications for Tympanostomy tubes - Acute Otitis Media

Answer 2

Recurrent AOM + Middle ear effusion in either ears at the time of assessment for tube candidacy. One should not place tubes in a child who does not have a middle ear effusion at the time of evaluation.

Question 3

Adenoidectomy and AROM?

Answer 3

Adenoidectomy has not been shown to reduce the number of episodes of AOM.

Question 4

Antibiotic therapy and AOM

1. Prophylactic Abx?
2. Abx for MEE?

Answer 4

1. No prophylactic antibiotics
2. Antibiotics has not been shown to speed up resolution of middle ear fluid or prevent development of an asymptomatic MEE

Question 5

Acute Otitis Media - Indications for Antibiotic Therapy

Answer 5

1. Children 48 hours; > 6 months old; temp > 102.2 - give abx.
2. Mild otalgia; 24 months - Abx or close f/u. Parental decision.

Question 6

Acute Otitis Media - Antibiotic Choices: No PCN Allergy

Answer 6

1. Amoxil: first line therapy in patient who has not had Amoxil in past 30 days and who has no conjunctivitis.
2. Augmentin: in pt who has had Amoxil in the past 30 days or who have purulent conjuctivitis.
3. Ceftriaxone: in child who fails initial abx - give Augmentin or Ceftriaxone.

Question 7

Acute Otitis Media - Antibiotic Choices: PCN Allergy

Answer 7

1. If allergic to Amoxil, and no prior type I IgE mediated Allergy: Omnicef, Vantin, Ceftin.
2. If has prior type I IgE mediated allergy to Amoxil: Zithromax, Biaxin.

Question 8

Antibiotic Dosages - Acute Otitis Media:

1. Amoxil
2. Omnicef
3. Vantin
4. Ceftin/Zinacef
5. Zithromax
6. Biaxin

Answer 8

1. Amoxil: 40 - 90mg/kg/day divided BID
2. Omnicef: 14mg/kg/day divided BID
3. Vantin: 10mg/kg/day once daily
4. Ceftin/Zinacef: 30mg/kg/day divided BID
5. Zithromax: 10mg/kg/day on day 1 followed by 5mg/kg/day x 4 more days as a single dose
6. Biaxin: 15mg/kg/day divided BID

Question 9

Chronic Otitis Media with Effusion: Effectiveness of Non surgical therapy:

1. Oral Abx
2. Mucolytics
3. Antihistamines
4. Decongestants
5. Topical nasal steroids
6. Oral steroids
7. Autoinflation

Answer 9

1. Oral Antibiotics - ineffective
2. Mucolytics - ineffective
3. Antihistamines - ineffective
4. Oral decongestants - ineffective
5. Topical Nasal steroids - ineffective
6. Oral steroids + oral abx - short term, but no long term benefit.
7. Autoinflation: Has been shown to speed resolution of MEE/OME.

Question 10

Chronic Otitis Media with Effusion present for 3 months: Likelihood of spontaneous resolution.

Answer 10

1. Additional 3 months: 20%
2. Additional 6 months: 25%
3. Additional 1 year: 30%

Question 11

Chronic Otitis Media with Effusion - Indications for Surgery

Answer 11

1. If a MEE has been present > 3 months and hearing loss is present on Audio - offer BMT
2. Should not offer BMT in children with a single episode of OME of less than 3 months duration.
3. Can consider BMT if there is COME and no hearing loss if child has other sxs relating to the MEE: imbalance, poor school performance, ear pain, behavioral probs.
4. Developmentally at risk child (Down’s/Cleft palate) - if MEE present > 3 months, consider BMT

Question 12

Should you place tympanostomy tubes in a child for Otitis Media with Effusion of less than 3 months’ duration?

Answer 12

You should not perform tympanostomy tube insertion in children with a single episode of OME of less than 3 months’ duration from the date of onset (if known) or from the date of diagnosis (if onset is unknown).

Source:
KAS Statement 1 from the AAOHNS 2022 CPG for Tympanostomy Tubes in Children

Question 13

Should you perform a hearing evaluation in patients with Otitis Media with Effusion that persists for 3 months or longer?

Answer 13

You should obtain a hearing evaluation if OME persists for 3 months or longer OR prior to surgery when a child becomes a candidate for tympanostomy tube insertion.

Source:
2022 AAOHNS CBG on Tympanostomy Tube Placement in Children

Question 14

What is the Definition of Acute Recurrent Otitis Media?

Answer 14

Three or more well-documented and separate Acute Otitis Media episodes in the last 6 months OR at least 4 well-documented and separate acute otitis media episodes in the last 12 months with at least 1 in the past 6 months.

Source:
2022 AAO-HNS CPG on Tympanostomy Tubes in Children

Question 15

What is the definition of Chronic Otitis Media with Effusion?

Answer 15

Otitis media with effusion that persists for 3 months or longer from the date of onset (if known) or from the date of diagnosis (if onset unknown).

Source:
2022 AAOHNS CPG for Tympanostomy Tubes in Children

Question 16

What is the definition of Persistent Otitis Media?

Answer 16

Persistent otitis media is the persistence of symptoms or signs of AOM during antibiotic therapy (treatment failure) and/or relapse of AOM within 1 month of completing antibiotic therapy. When 2 episodes of otitis media occur within 1 month, it may be difficult to distinguish recurrence of AOM (ie, a new episode) from persistent otitis media (ie, relapse).

Source:
2022 AAO-HNS CPG on Tympanostomy Tubes in Children

Question 17

Tympanostomy tube placement for otitis media with effusion of short duration

Answer 17

Tympanostomy tubes should not be placed in a child with a single episode of Otitis Media with Effusion of less than 3 months’ duration from the last date of onset (if known) or from the date of diagnosis (if onset is unknown).

Question 18

Should one perform a hearing evaluation in a patient with otitis media with effusion?

Answer 18

A hearing evaluation should be obtained in a patient with otitis media with effusion that persists for 3 months or longer OR prior to surgery when a child becomes a candidate for tympanostomy tube insertion.

Question 19

What is the definition of normal hearing in a child?

Answer 19

Normal hearing is now considered to be hearing thresholds of less than 15dB.

Question 20

When should tympanostomy tube placement be offered to a child with bilateral otitis media with effusion?

Answer 20

Tympanostomy tube placement should be offered to a child who has had bilateral otitis media with effusion for 3 months or longer AND document hearing difficulties.