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Chapter 5
Primary Care Otolaryngology
of resistant organisms in your community, a common second-line therapy
for acute otitis media is high-dose amoxicillin-clavulanate.
Breastfeeding and vaccination with a
pneumococcal conjugate preparation
may decrease the incidence of acute
otitis media in children, while other
factors, such as daycare attendance,
young siblings at home, and exposure to
tobacco smoke, may predispose chil-
dren to develop otitis media. Some chil-
dren develop
recurrent acute otitis
media,
or
recurring acute, symptomatic
ear infections
.
Such children may ben-
efit from
pressure equalization (PE)
tube, or ear tube, insertion
if they have
three to four bouts of acute otitis media
in six months or five to six bouts in a
single year.
Insertion of PE tubes involves placing small tubes in the eardrum to venti-
late the middle ear and prevent the negative pressure and fluid buildup. In
a child with an open PE tube, ear drainage typically indicates an ear infec-
tion. An advantage of PE tubes is the ability to treat episodes of ear drain-
age with topical antibiotic therapy, such as fluoroquinolone ototopical
drops applied to the ear canal. Currently, there is a trend to use fluoroqui-
nolone drops rather than traditional neomycin/polymyxin B/hydrocorti-
sone preparations, due to the theoretical risk of ototoxicity associated with
these medications. The PE tubes generally extrude on their own after one
to two years. In the past, antibiotic prophylaxis for a three- to six-month
trial was an alternative treatment for children with recurrent acute otitis
media. Due to concern over the development of resistant organisms, the
routine use of antibiotic prophylaxis for recurrent acute otitis media in
otherwise healthy children has been largely abandoned.
OME, or middle ear fluid without active infection, may occur after treat-
ment of an acute episode of otitis media, or due to chronic eustachian tube
dysfunction. While the majority of children will clear middle ear fluid
within three months of an acute ear infection, those with eustachian tube
dysfunction may have problems with persistent middle ear fluid. Children
with OME are often asymptomatic, although they may complain of ear
fullness or muffled hearing. These patients do not have the fevers, irritabil-
ity, and ear pain that are associated with acute otitis media. On physical
Figure 5.2.
Photograph of a tympanic membrane with a
pressure equalizing (PE) tube in place. The
tube permits aeration of the middle ear space.