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