Overview
The lecture covers the diagnosis and management of otitis media, emphasizing diagnostic signs, treatment guidelines, and appropriate antibiotic use in children.
Types of Otitis Media
- Acute otitis media (AOM) is diagnosed by a bulging, cloudy tympanic membrane (TM) with limited mobility on pneumatic otoscopy.
- Otitis media with effusion involves fluid behind the TM without signs of systemic infection.
Diagnosis
- Normal TMs are pearly gray and mobile; infected TMs are bulging, cloudy, and immobile.
- Redness alone is not a key criterion for AOM diagnosis.
- Pneumatic otoscopy helps determine TM mobility; immobility suggests fluid or pus, supporting AOM diagnosis.
- The American Academy of Pediatrics (AAP) provides guidelines to help decide between antibiotics and observation.
Treatment Guidelines
- Children <6 months: Antibiotics recommended if AOM is suspected or confirmed.
- Children 6 months–2 years: Antibiotics if the child appears ill.
- Children >2 years: Observation is preferred unless symptoms are severe or persistent.
- Most cases are viral; bacterial cases are commonly caused by Streptococcus pneumoniae, now covered by vaccines.
- Effective follow-up is essential to monitor progression and avoid unnecessary antibiotics.
Antibiotic Choices
- Amoxicillin is the first-line antibiotic for most uncomplicated cases without recent antibiotic exposure.
- High-dose amoxicillin (80–90 mg/kg/day divided) is recommended to cover drug-resistant S. pneumoniae.
- Augmentin is preferred if there is amoxicillin failure or use in the last 30 days, due to possible beta-lactamase producers.
- Cephalosporins may be considered if there is a remote penicillin allergy.
- Always address pain management for symptomatic relief.
Key Terms & Definitions
- Tympanic Membrane (TM) — Eardrum that separates the outer ear from the middle ear.
- Acute Otitis Media (AOM) — Middle ear infection with signs of inflammation and fluid.
- Otitis Media with Effusion — Presence of fluid in the middle ear without acute infection signs.
- Pneumatic Otoscopy — Technique using air to assess TM mobility.
- Beta-lactamase producer — Bacteria producing enzymes that deactivate certain antibiotics.
Action Items / Next Steps
- Review AAP guidelines for otitis media management.
- Practice identifying key TM findings with otoscopy.
- Ensure follow-up procedures are in place for otitis media cases.