Acute otitis media ( AOM )

Acute Otitis Media ( AOM ) is defined as the presence of inflammation
 in the middle ear accompanied by the rapid onset 
of signs and symptoms of an ear infection

Otitis media with effusion ( OME ) previously called OM or secretory OM is middle ear effusion of any duration that lacks the associated signs and symptoms of infection. OME usually follows an episode of AOM

AOM is a highly prevalent condition with 50-80 % of children affected by 3 yrs of age Second most common disease of childhood ( particularly < 5 yrs ) Less common in adults ( < 1 % ) Peaks between 6-15 months One of the most common reasons for prescribing antibiotics Complications such as mastoiditis are rare ( ie high morbidity low mortality )

Can be caused by both bacterial and viral infection -viral / bacterial co-infection is also common Respiratory viruses account for most cases of OM and are self limiting

risk factors

Day care attendance Older siblings ( having suffered AOM ) Young age Family history Absence of breast feeding Supine feedings ( bottle propping ) Craniofacial abnormalities ( eg Down’ syndrome or cleft palate ) Lower socioeconomic status Immunological deficiency Native Americans and Eskimos , whites > African- Americans Male sex Dummy use Environmental tobacco use

Recurrent AOM

Adenoid hypertrophy Pacifier ( dummy ) user Early age of 1st AOM ( particularly < 6 months ) GORD Flat supine feeding Winter Breast feeding < 3 months

presentation

Often a h/o preceding URTI Otalgia Otorrhoea -discharge from TM through a
 perforation There may be
♦ fever
♦ irritability
♦ ear pulling , tugging or
 rubbing 
♦ vomiting , diarrhoea
♦ pain on swallowing
♦ crying
♦ poor feeding
♦ restlessness at night
♦ cough or rhinorrhoea Hearing loss Tinnitus ( possible but is an unusual complaint from a child ) Vertigo Eye drainage -infections 2ary to non-typable H influenza often associated with conjunctivitis

When examining the TM pay attention to the following four characteristics
Colour
Position
Mobility
Perforation
 Red yellow or cloudy TM
Normal TM is a translucent pale gray
 Moderate-to-severe bulging of TM
Normally TM is in neutral position ie neither retracted nor bulging
 An air-fluid level behind the TM
 Perforation of the TM and / or discharge in th external auditory canal


differential -Otitis media with effusion ( glue ear )
This is not accompanied by symptoms or signs of acute inflammation of the TM
 Chronic suppurative otitis media
persistent inflammation and perforatiom of TM with draining exudate for > 2 weeks
 Myringitis Other respiratory tract infections ( mild redness of the TM may be noticed ) ie redness of TM is not specific to AOM Mastoiditis Cholesteatoma

Complication- Recurrence of infection Hearing loss – usually conductive and temporary TM perforation Otitis hydrocephalus ( rare ) Other rare
mastoiditis
meningitis
intracranial abscess
sigmoid sinus thrombosis
VIIth cranial N palsy

Otitis media ( acute ) Antimicrobial prescribing NICE ( 2018 ) Anaesthetic ear drops may improve pain but not licensed for use in UK Little evidence to support use of decongestants or antihistamines
 Antibiotics make little difference to how long symptoms last or the number of children whose symptoms improve
 Antibiotics make little difference to number of children with recurrent infections , hearing loss or perforated ear drum
 Complications ( such as mastoiditis ) are rare whether antibiotics are given or not


AOM is a self limiting infection that mainly affects children Frequently presents with ear pain which may manifest as ear pulling or rubbing in young preverbal children AOM may be caused by viruses and bacteria – it difficult to distinguish between these ( both may often be present at the same time ) A bulging , opacified TM with decreased mobility Symptoms last for about 3 days , but can last up to a week Most children and young people get better within 3 days without antibiotics Complications are rare

References
CKS NHS Otitis media- acute July 2015
E Medicine Acute Otitis Media ( AOM ) March 2018
Shin JJ.Antibiotics administered for acute otitis media have modest benefits and adverse effects BMJ Evidence-Based Medicine 2016 ;21; 181 ( Abstract ) Otitis Media : Acute Otitis Media ( AOM ) and Otitis Media with Effusion ( OME ) BC Guidelines. ca Otitis Medua ( acute ) : antimicrobial prescribing NICE guideline March 2018 BMJ Best Practice Acute Otitis Media Most cases of otitis media should not be treated with antibiotics , says NICE BMJ 2017 ; 358: J;4398 Acute otitis media ( AOM ) overview and Recommendations DynaMed Plus Acute Otitis Media and Otitis Media with Effusion Pediatric Clerkship The University of Chicago Antibiotic prescribing Otitis Media NICE -https://www.nice.org.uk/guidance/ng91

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