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AOM
Otitis Media Otitis Media with effusion (OME)
Acute Otitis Media (AOM)
Recurrent AOM
Chronic Otitis Media/Chronic Otitis Media with effusion
Chronic Suppurative Otitis Media (CSOM)
Epidemiology Seasonal Peak: winter months
90% of children have at least one symptomatic or asymptomatic episode by 2yrs of age
Incidence Peaks: 6-18months of age
Risk Factors Age <2yrs
Atopy
Bottle propping
Chronic sinusitis
Ciliary dysfunction
Cleft palate and craniofacial anomalies
Child Care attendance
Down Syndrome and other genetic conditions
Pathogenesis Impaired eustachian tube function
Negative pressure increases
Nasopharyngeal contents are aspirated into middle ear
Increased vascular permeability: development of MEE
Viruses RSV
Paraflu (types 1,2,3)
Influenza (type A and B)
Adenovirus
Coronavirus
Bacteria Streptococcus Pneumoniae
Nontypeable Hemophilus influenza
Moraxella catarrhalis
S. pyogenes (Group A strep)
Staph Aureus (less common)
PE: OME vs AOM Fluid in middle ear space
AOM: inflammation, specifically otalgia and fever
OME: TM appears opaque or cloudy
AOM: red or dark-yellow discoloration of TM or bulging of TM
Normal TM
OME
AOM
Management Observation
Treatment
Management <6months: antibacterial therapy
6months to 2years with certain diagnosis: antibacterial therapy
6months to 2 years with uncertain diagnosis: antibacterial therapy or observation
2yrs and up with certain diagnosis: antibacterial therapy or observation
2yrs and up with uncertain diagnosis: observation
Antibiotic High dose amoxicillin: 80-90mg/kg/day
Alternative for penicillin allergy
Augmentin 90mg/kg per day of amox component
Ceftriaxone
Clindamycin
Complications Mastoiditis
Acute labyrinthitis
Petrositis
Meningitis
Brain Abscess
Epidural Abscess
Otitic hydrocephalus