Primary Care Otolaryngology

Chapter 5

Otitis Media

Otitis media may simply be defined as inflammation of the middle ear space —the space between the eardrum and the inner ear—due to any cause. It is the second most common disease diagnosed in young children. Otitis media can be classified by duration, patient symptoms, and physical exam findings. It is important for the clinician to be familiar with two com- mon variants of otitis media: (1) acute otitis media and (2) otitis media with effusion (OME) .

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Children with acute otitis media frequent- ly present with sudden onset of fever, ear pain, and fussiness. In patients with acute otitis media, the eardrum is bulging and yellow or white in color with dilated ves- sels, and there is decreased movement of the eardrum on pneumatic otoscopy (insufflation of air into the ear canal). Common bacteria that cause acute otitis media in children are Streptococcus pneu- moniae , Haemophilus influenzae , and Moraxella catarrhalis . In healthy children older than two years of age who present with less severe symptoms, observation for 48 hours may be considered. If the deci-

Figure 5.1. This tympanic membrane demonstrates the bulging seen with an acute infection.

sion is made to treat with antibacterial agents, amoxicillin dosed at 80 to 90 milligrams per kilogram per day is the first-line antibiotic therapy. Azithromycin can be used to treat patients who have a penicillin allergy. The high incidence of resistant organisms can make the treatment of acute otitis media challenging. For example, in patients who do not respond to first-line antibiotic therapy, a beta-lactamase-producing organism or a resistant Streptococcus organism may be responsible for treatment failure. While treatment choices in such patients will be dictated by the prevalence

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