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Otitis Media - Current Guidelines in Management

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Dr Jagdish Chinnappa, Bengaluru    15 January 2018

  1. Otitis media is associated with signifi cant morbidity and mortality, hearing loss, antibiotic use.
  2. There is a paucity of trained pediatric ENT services.
  3. Spectrum of otitis media.
  4. There is paucity of data about which antibiotic to give. Consensus is that amoxicillin with or without clavulanic acid can be given.
  5. In children <2 years of age, and those with severe disease, duration of treatment of 10 days is ideal.
  6. A 2014 study revealed that oral antibiotics shortened the period of middle ear effusion following acute otitis media.
  7. Treatment of pain – Paracetamol/NSAIDs (ibuprofen/mefenamic acid) can be given; local anesthetic/analgesic drops are more effective than placebo in reduction of pain at 30 minutes.
  8. Accurate diagnosis should be established by pneumatic otoscopy/tympanometry.
  9. Regular follow-up is essential.
  10. Guidelines for OME (USA, South Korea, Netherlands and Denmark; RTI Gems): Age-appropriate hearing assessment; watchful waiting (except in high-risk group); follow-up every 3 months with hearing testing; shared decision making; adenoidectomy and tonsillectomy to be considered only if upper airway disease is present.
  11. Adherence to guidelines is suboptimal, except in Denmark where antibiotics are prescribed appropriately.
ConditionDiagnosisInvestigationsGuidelines on treatment
AOMClinical; pneumatic; otoscopy; tympanometryRapid diagnostics; tympanocentesis; nasopharyngeal swabConservative above 2 years; Amoxicillin for most; amoxicillin-clavulanic acid in selected cases
rAOMAll the above + accurate record keepingAll the above + documentation of normal drums inter-episodeAirway assessment; assessment of comorbidities, environmental issues, genetics
OMEAll the above + hearing assessmentAudiometry follow-up 
 Wait and watch; tympanostomy tubes (TT); Adenoidectomy; tonsillectomy  
Chronic suppurative otitis media (CSOM)Clinical scenarioENT for cholesteatomaLocal quinolone ear drops + steroids; no aminoglycoside
MastoiditisWorsening on treatment for AOMImaging; rapid diagnostics; cultureAggressive parenteral antibiotics/TT; needle aspiration; mastoidectomy

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