ACUTE OTITIS MEDIA (AOM) (Definition ( (occurs frequently in children but…
ACUTE OTITIS MEDIA (AOM)
Defined as the presence of inflammation in the middle ear, associated with an effusion and accompanied by the rapid onset of symptoms and signs of an ear infection.
occurs frequently in children but is less common in adults:
More than 75% of episodes of AOM occur in children younger than 10 years of age [COMPASS, 2009].
Peak incidence occurs between 6 and 15 months of age [Sanders et al, 2004].
There is a slight increased incidence of AOM in males compared with females
Acute onset of symptoms,including:
In older children and adults — earache.
In younger children — pulling, tugging, or rubbing of the ear, or non-specific symptoms such as fever,
irritability, crying, poor feeding, restlessness at night, cough, or rhinorrhoea.
A distinctly red, yellow, or cloudy tympanic membrane.
Moderate to severe bulging of the tympanic membrane, with loss of normal landmarks.
An air-fluid level behind the tympanic membrane.
Perforation of the tympanic membrane and/or discharge in the external auditory canal.
Differential diagnosis -
Other upper respiratory tract infections — mild redness of the tympanic membrane may be seen.
Otitis media with effusion (glue ear) — fluid in the middle ear without symptoms or signs of acute inflammation of the tympanic membrane.
Chronic suppurative otitis media — persistent inflammation and perforation of the tympanic membrane with draining exudate for more than 2 weeks. There may be associated cholesteatoma.
Bullous myringitis (rare)
abx not indicated
For all other people with AOM: Treat pain and fever with paracetamol or a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen.
Consider switching to the other agent if the child remains distressed.
Only consider alternating between paracetamol and ibuprofen
For most people, advise either a no antibiotic prescribing strategy, or a delayed antibiotic prescribing strategy
Offer an immediate antibiotic prescription to people:
Who are systemically unwell but do not require admission.
Who are at high risk of serious complications because of significant heart, lung,
kidney, liver, or neuromuscular disease; or who are immunocompromised.
Whose symptoms have lasted for 3 days or more and are not improving.
If an antibiotic is required:
Prescribe a 5-7 day course of amoxicillin.
For people who are allergic to penicillin, prescribe a 5-7 day course
of erythromycin or clarithromycin.
Admit for immediate paediatric assessment, children younger than 3 months of age with a temperature of 38°C or more
Admit for immediate specialist assessment, adults and children with suspected acute complications of acute otitis media (AOM), such as meningitis, mastoiditis, or facial nerve paralysis.
People who are systemically very unwell.
Children younger than 3 months of age.
Children 3–6 months of age with a temperature of 39°C or more.