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Acute otitis media

Properties2
tagst1
aliasesOtitis media

2 min read

Epidemiology

  • Most common pediatric bacterial infection; peak incidence age 6–24 months.
  • Etiology (Bacterial):
    • Streptococcus pneumoniae (most common overall).
    • Nontypeable Haemophilus influenzae.
    • Moraxella catarrhalis.
  • Etiology (Viral): RSV, Rhinovirus, Influenza (frequently precedes bacterial infection).
  • Risk Factors:
    • Daycare attendance.
    • Passive exposure to tobacco smoke.
    • Lack of breastfeeding / bottle feeding while supine.
    • Pacifier use > 6 months of age.
    • Craniofacial anomalies (e.g., cleft palate, Down syndrome).
    • Young age (short, horizontal Eustachian tubes).

Etiology

Tip

  • Acute Otitis Media (AOM): Caused by respiratory bacteria following a URI, mainly S. pneumoniae, nontypeable H. influenzae, and M. catarrhalis.
  • Otitis Externa (OE): Caused by skin/water flora due to canal moisture/trauma (Swimmer’s Ear), most commonly Pseudomonas aeruginosa and S. aureus.

Pathophysiology

Clinical features

  • History:
    • Acute onset otalgia (infants present with ear tugging/pulling, irritability, poor sleep/feeding).
    • Fever.
    • Antecedent viral URTI.
  • Physical Exam (Otoscopy):
    • Bulging tympanic membrane (TM) (most specific diagnostic finding).
    • Erythematous TM, loss of landmark light reflex, opacification.
    • Decreased TM mobility on pneumatic otoscopy.
    • Otorrhea (indicates acute TM perforation).

Diagnostics

Treatment

  • Analgesia: First-line for all patients (Oral acetaminophen or ibuprofen).
  • Initial Antibiotic Therapy:
    • First-line: High-dose Oral Amoxicillin (80-90 mg/kg/day).
  • Observation vs Immediate Antibiotics:
    • Immediate Antibiotics Required:
      • Age < 6 months (regardless of severity).
      • Age ≥ 6 months with severe signs/symptoms (high fever ≥ 39°C/102.2°F, severe otalgia, otalgia > 48h).
      • Bilateral AOM in children < 2 years.
      • AOM with otorrhea.
    • Observation (48–72h safety-net prescription): Option for mild, unilateral AOM in children ≥ 6 months.
  • Second-Line Therapy:
    • Amoxicillin-clavulanate (Augmentin): Indicated if treatment failure after 48-72h of amoxicillin, recent amoxicillin use within 30 days, or concurrent purulent conjunctivitis.
  • Penicillin Allergy:
    • Non-severe allergy: Oral 2nd/3rd gen cephalosporin (e.g., Cefdinir, Cefuroxime, Cefpodoxime).
    • Severe allergy (anaphylaxis): Azithromycin, Clarithromycin, or IM Ceftriaxone.
  • Recurrent AOM:
    • Definition: ≥ 3 episodes in 6 months OR ≥ 4 episodes in 12 months (with ≥1 in past 6 months).
    • Management: Tympanostomy tube placement (myringotomy with tube insertion).

Complications

Otogenic abscess

Temporal lobe abscess

Graph View

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