Acute otitis media (AOM) is diagnosed on the basis of acute onset of pain and fever; a red, bulging tympanic membrane; and middle ear effusion.
AOM is managed with analgesia (paracetamol or non-steroidal anti-inflammatory drugs). Antibiotic therapy is minimally effective for most patients; it is most effective for children < 2 years with bilateral otitis media and for children with discharging ears. National guidelines recommend antibiotic therapy for Indigenous children with AOM. Evidence for corticosteroids, topical analgesia and xylitol are scant.
Otitis media with effusion (OME) is diagnosed as the presence of middle ear effusion (type B tympanogram or immobile tympanic membrane on pneumatic otoscopy) without AOM criteria.
Well children with OME with no speech and language delays can be observed for the first 3 months; perform audiological evaluation and refer to an ear, nose and throat (ENT) specialist if they have bilateral hearing impairment > 30 dB or persistent effusion. Children with effusions persisting longer than 3 months can benefit from a 2–4-week course of amoxycillin.
Chronic suppurative otitis media is a chronic discharge through a tympanic membrane perforation. It is managed with regular ear cleaning (dry mopping or povidone–iodine [Betadine] washouts) until discharge resolves; topical ear drops (eg, ciprofloxacin); audiological evaluation; and ENT review.
- 1. Leach AJ, Boswell JB, Asche V, et al. Bacterial colonization of the nasopharynx predicts very early onset and persistence of otitis media in Australian Aboriginal infants. Pediatr Infect Dis J 1994; 13: 239-247.
- 2. Morris PS. A systematic review of clinical research addressing the prevalence, aetiology, diagnosis, prognosis and therapy of otitis media in Australian Aboriginal children. J Paediatr Child Health 1998; 34: 487-497.
- 3. Nyquist A-C, Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis. JAMA 1998; 279: 875-877.
- 4. Froom J, Culpepper L, Green LA, et al. A cross-national study of acute otitis media: risk factors, severity, and treatment at initial visit. Report from the international primary care network (IPCN) and the ambulatory sentinel practice network (ASPN). J Am Board Fam Pract 2001; 14: 406-417.
- 5. Davidson J, Hyde ML, Alberti PW. Epidemiologic patterns in childhood hearing loss: a review. Int J Pediatr Otorhinolaryngol 1989; 17: 239-266.
- 6. Roberts JE, Rosenfeld RM, Zeisel SA. Otitis media and speech and language: a meta-analysis of prospective studies. Pediatrics 2004; 113: e238-e248.
- 7. Morris P, Ballinger D, Leach A, et al. Recommendations for clinical care guidelines on the management of otitis media (middle ear infection) in Aboriginal and Torres Strait Islander populations. Canberra: Office for Aboriginal and Torres Strait Islander Health, Commonwealth Department of Health and Aged Care, 2001.
- 8. Antibiotic Expert Group. Therapeutic guidelines: antibiotic. Version 13. Melbourne: Therapeutic Guidelines Limited, 2006.
- 9. American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics 2004; 113: 1451-1465.
- 10. Heikkinen T, Thint M, Chonmaitree T. Prevalence of various respiratory viruses in the middle ear during acute otitis media. N Engl J Med 1999; 340: 260-264.
- 11. Sanders S, Glasziou PP, Del Mar C, Rovers M. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev 2009. In press.
- 12. Rovers MM, Glasziou P, Appelman CL, et al. Antibiotics for acute otitis media: a meta-analysis with individual patient data. Lancet 2006; 368: 1429-1435.
- 13. Ashworth M, Latinovic R, Charlton J, et al. Why has antibiotic prescribing for respiratory illness declined in primary care? A longitudinal study using the General Practice Research Database. J Public Health (Oxf) 2004; 26: 268-274.
- 14. Kim SY, Chang YJ, Cho HM, et al. Non-steroidal anti-inflammatory drugs for the common cold. Cochrane Database Syst Rev 2009; (3): CD006362.
- 15. Meremikwu M, Oyo-Ita A. Paracetamol for treating fever in children. Cochrane Database Syst Rev 2002; (2): CD003676.
- 16. Hayward G, Thompson M, Heneghan C, et al. Corticosteroids for pain relief in sore throat: systematic review and meta-analysis. BMJ 2009; 339: b2976.
- 17. Zalmanovici A, Yaphe J. Steroids for acute sinusitis. Cochrane Database Syst Rev 2007; (2): CD005149.
- 18. Thomas M, Del Mar C, Glasziou P. How effective are treatments other than antibiotics for acute sore throat? Br J Gen Pract 2000; 50: 817-820.
- 19. Foxlee R, Johansson A, Wejfalk J, et al. Topical analgesia for acute otitis media. Cochrane Database Syst Rev 2006; (3): CD005657.
- 20. Hildebrandt G, Lee IK. Xylitol containing oral products for preventing dental caries [protocol]. Cochrane Database Syst Rev 2004; (1): CD004620.
- 21. Uhari M, Kontiokari T, Koskela M, et al. Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial. BMJ 1996; 313: 1180-1184.
- 22. Bluestone CD, Klein JO. Otitis media and eustachian tube dysfunction. In: Bluestone CD, Stool SE, Alper CM, et al, editors. Pediatric otolaryngology. 4th ed. New York: Saunders, 2003: 474-685.
- 23. McDonald S, Langton Hewer CD, Nunez DA. Grommets (ventilation tubes) for recurrent acute otitis media in children. Cochrane Database Syst Rev 2008; (4): CD004741.
- 24. Cantekin EI, McGuire TW. Antibiotics are not effective for otitis media with effusion: reanalysis of meta-analyses. Otorhinolaryngol Nova 1998; 8: 214-222.
- 25. American Academy of Pediatrics. Clinical practice guideline: otitis media with effusion. Pediatrics 2004; 113: 1412-1429.
- 26. Thomas CL, Simpson S, Butler C, van der Voort J. Oral or topical nasal steroids for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev 2006; (3): CD001935.
- 27. Simpson S, Thomas CL, van der Linden M, et al. Identification of children in the first four years of life for early treatment for otitis media with effusion. Cochrane Database Syst Rev 2007; (1): CD004163.
- 28. Williams RL, Chalmers TC, Stange KC, et al. Use of antibiotics in preventing recurrent acute otitis media and in treating otitis media with effusion. A meta-analytic attempt to resolve the brouhaha. JAMA 1993; 270: 1344-1351.
- 29. Rosenfeld RM, Post JC. Meta-analysis of antibiotics for the treatment of otitis media with effusion. Otolaryngol Head Neck Surg 1992; 106: 378-386.
- 30. Perera R, Haynes J, Glasziou PP, Heneghan CJ. Autoinflation for hearing loss associated with otitis media with effusion. Cochrane Database Syst Rev 2006; (4): CD006285.
- 31. Lous J, Burton MJ, Felding J, et al. Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev 2005; (1): CD001801.
- 32. Paradise JL, Feldman HM, Campbell TF, et al. Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med 2007; 356: 248-261.
- 33. Chow Y, Wabnitz DA, Ling J. Quality of life outcomes after ventilating tube insertion for otitis media in an Australian population. Int J Pediatr Otorhinolaryngol 2007; 71: 1543-1547.
- 34. Rosenfeld RM, Bhaya MH, Bower CM, et al. Impact of tympanostomy tubes on child quality of life. Arch Otolaryngol Head Neck Surg 2000; 126: 585-592.
- 35. Macfadyen CA, Acuin JM, Gamble CL. Systemic antibiotics versus topical treatments for chronically discharging ears with underlying eardrum perforations. Cochrane Database Syst Rev 2006; (1): CD005608.
- 36. van der Veen EL, Rovers MM, Albers FWJ, et al. Effectiveness of trimethoprim/sulfamethoxazole for children with chronic active otitis media: a randomized, placebo-controlled trial. Pediatrics 2007; 119: 897-904.
- 37. Palmu A, Jokinen J, Kilpi T; Finnish Otitis Media Study Group. Impact of different case definitions for acute otitis media on the efficacy estimates of a pneumococcal conjugate vaccine. Vaccine 2008; 26: 2466-2470.
- 38. Prymula R, Peeters P, Chrobok V, et al. Pneumococcal capsular polysaccharides conjugated to protein D for prevention of acute otitis media caused by both Streptococcus pneumoniae and non-typable Haemophilus influenzae: a randomised double-blind efficacy study. Lancet 2006; 367: 740-748.
- 39. Kay ES, Ng K, Salmon A, Del Mar C. Influenza vaccine for preventing acute otitis media in infants and children. Cochrane Database Syst Rev 2005; (3): CD005438.
- 40. American Academy of Otolaryngology, Head and Neck Surgery. 2000 Clinical indicators compendium. Alexandria, Va: AAOHNS, 2000: 10, 15-16.
- 41. The Otitis Media Guideline Panel. Managing otitis media with effusion in young children. American Academy of Pediatrics. Pediatrics 1994; 94: 766-773.
- 42. American Academy of Otolaryngology, Head and Neck Surgery. Ear problems in childhood. Revised Referral Guideline Kit. Alexandria, Va: AAOHNS, 2000.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.