Acute Otitis Media (AOM)

Introduction

• Definition: Infection of the middle ear space.
• Commonality: Second most common pediatric diagnosis after upper respiratory infections, especially in children aged 6-24 months.
• Epidemiology: 80% of children will experience AOM; 80-90% will have otitis media with effusion before school age.

Etiology

• Infectious Agents:
  • Bacterial: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis.
  • Viral: RSV, coronaviruses, influenza viruses, etc.
• Risk Factors:
  • Immunodeficiencies (HIV, diabetes), genetic predisposition, anatomical abnormalities, environmental factors, etc.

Pathophysiology

• Follows a viral upper respiratory infection.
• Inflammation leads to obstruction in the Eustachian tube, decreased ventilation, buildup of fluids, and microbial colonization.

Clinical Presentation

• Symptoms: Ear pain, irritability, fever, poor feeding.
• Diagnosis: Clinical findings (otoscopy), history, and symptoms. No lab or imaging required unless complications are suspected.

Evaluation and Diagnosis

• Physical Exam: Otoscopic examination essential; pneumatic otoscopy preferred.
• Laboratory Studies: Rarely needed unless ruling out systemic infection.
• Imaging Studies: Only if complications like mastoiditis or brain abscess are suspected.

Treatment and Management

• Pain Management: NSAIDs or acetaminophen.
• Antibiotic Therapy:
  • First Line: High-dose amoxicillin (10 days).
  • Alternatives for penicillin allergy: Azithromycin, cefdinir, cefuroxime.
• Watchful Waiting: Common in Europe, not widely accepted in the US.
• Surgical Interventions: Myringotomy with tube placement for recurrent AOM.

Complications

• Intratemporal: Hearing loss, TM perforation, mastoiditis, facial paralysis.
• Intracranial: Meningitis, brain abscess, lateral sinus thrombosis.

Prognosis

• Generally excellent with early diagnosis and treatment.
• Complications can lead to high recurrence and possible hearing loss affecting language development.

Prevention and Education

• Vaccinations (pneumococcal, influenza) reduce URTI.
• Avoid tobacco smoke exposure and encourage breastfeeding.

Interprofessional Care

• Involves physicians, audiologists, nurses, pharmacists, and speech pathologists for comprehensive management and better outcomes.