Pediatric Illness Guidelines – Acute Otitis Media

Pediatric Illness Guidelines – Acute Otitis Media

Acute otitis media (AOM) refers to middle ear infection and is a common and concerning child ailment. It is a disease that occurs commonly after a cold or any respiratory illness and causes earache, irritability, and sometimes fever. AOM is the leading reason for pediatric outpatient care visits and a common reason for antibiotic prescriptions. Appropriate and efficient management of AOM is inevitably important to decrease symptoms and also to prevent complications. This discussion also aims to provide a brief understanding of AOM, its factors, signs and indicators, diagnosis, and management for the provision of the best care to young patients.

Etiology

AOM is most often caused by bacteria, and the three main types are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Other potential causes include RSV, rhinoviruses, and influenza viruses that cause eustachian tube dysfunction and then bacterial invasion (Pacheco et al., 2021).

Epidemiology

AOM mainly affects children between the ages of six months and two years of age, but the incidence is greatest at one year of age. It is among the most frequently reported diagnoses for children’s pediatric care and antibiotic prescriptions in the USA (Jamal et al., 2022). Possible factors that might contribute to the development of AOM include young age, male gender, attendance at childcare centres, exposure to tobacco smoke, pacifier use, and poor breastfeeding.

Pathophysiology

AOM typically follows an upper respiratory tract infection (URI), which leads to inflammation and swelling of the nasopharyngeal mucosa. This process obstructs the eustachian tube, resulting in negative pressure and fluid accumulation in the middle ear. The trapped fluid fosters bacterial growth, causing infection and inflammation of the middle ear mucosa.

Clinical Manifestations

Children with AOM present with rapid onset of ear pain (otalgia), irritability, fever, and sometimes otorrhea (discharge from the ear if the tympanic membrane is perforated). Physical examination reveals a bulging, erythematous, and immobile tympanic membrane with purulent effusion visible behind it.

Work-up

The diagnosis of AOM is primarily clinical, based on history and otoscopic findings. Pneumatic otoscopy assesses tympanic membrane mobility, while tympanometry confirms middle ear effusion. In uncertain cases or recurrent/severe infections, tympanocentesis for culture may be warranted to identify the causative pathogen.

Nonpharmacological Management

Initial management may include observation, particularly in children over two years with mild symptoms and no otorrhea. Educating parents on signs of worsening infection and when to seek further medical care is essential (van Uum et al., 2020).

Pharmacological Management

Antibiotic therapy is indicated for children under six months, those with severe symptoms (moderate to severe otalgia or otalgia for more than 48 hours or fever ≥39°C), or those with bilateral AOM in children under two years. Amoxicillin is the first-line antibiotic due to its efficacy, safety, and cost-effectiveness. For patients with penicillin allergy, cefdinir, cefuroxime, cefpodoxime, or azithromycin may be used. Treatment duration ranges from 5 to 10 days, depending on the child’s age and symptom severity (Spicer et al., 2020).

Education

Parents should be educated on the importance of completing the full course of antibiotics even if symptoms improve. They should also be informed about the potential side effects of medications and the need for follow-up if symptoms do not resolve or worsen. Preventative measures such as breastfeeding, reducing pacifier use, and minimizing exposure to tobacco smoke should be discussed to lower the risk of recurrent AOM.

Follow-up

Follow-up is recommended to ensure the resolution of symptoms and effusion, particularly in young children or those with recurrent AOM. If effusion persists beyond three months or if there are concerns about hearing or speech development, referral to an otolaryngologist for further evaluation and possible tympanostomy tube placement may be necessary.

References

Jamal, A., Alsabea, A., Tarakmeh, M., & Safar, A. (2022). Aetiology, diagnosis, complications, and management of acute otitis media in children. Cureus, 14(8). https://doi.org/10.7759/cureus.28019

Pacheco, G. A., Gálvez, N. M. S., Soto, J. A., Andrade, C. A., & Kalergis, A. M. (2021). Bacterial and Viral Coinfections with the Human Respiratory Syncytial Virus. Microorganisms, 9(6), 1293. https://doi.org/10.3390/microorganisms9061293

Spicer, J. O., Roberts, R. M., & Hicks, L. A. (2020). Perceptions of the Benefits and Risks of Antibiotics Among Adult Patients and Parents With High Antibiotic Utilization. Open Forum Infectious Diseases, 7(12). https://doi.org/10.1093/ofid/ofaa544

van Uum, R. T., Venekamp, R. P., Zuithoff, N. P., Sjoukes, A., van de Pol, A. C., Schilder, A. G., & Damoiseaux, R. A. (2020). Improving pain management in childhood acute otitis media in general practice: a cluster randomized controlled trial of a GP-targeted educational intervention. British Journal of General Practice, 70(699), e684–e695. https://doi.org/10.3399/

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Week 2: Discussion Question – Pediatric Illness Guidelines
Discussion Prompt
Discuss Etiology, Epidemiology, Pathophysiology, Clinical Manifestations, Work-up, Nonpharmacological and Pharmacological Management, Education, and Follow-up for a pediatric diagnosis or pediatric care consideration. 500 words or less for the initial post. For example requirement, only evidence-based sources, such as AAFP, CDC, IDSA, ADA, JNC 8 etc.

Pediatric Illness Guidelines – Acute Otitis Media

(textbook resources and internet sites affiliated with medical associations are considered credible sources to obtain information on the most up-to-date guidelines). Add the link to the guideline(s) within the discussion board for further reading by your peers.