Acute otitis media (AOM), is an inflammatory process in the middle ear. Effusions or fluid in the middle ear occur when the eustachian tube cannot drain properly, typically because of edema triggered by infections most common viral. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common bacterial pathogens in AOM.
Symptoms associated with AOM are fever, ear discomfort, fussiness, or difficulty sleeping. Also, often associated symptoms of URI (Cold) are present like congestion, cough and rhinorrhea.
Treatment: When analyzing treatment options, factors like age, severity, frequency of ear infections needs to be taken into consideration. The American Academy of Pediatrics (AAP) recommends observation and pain control for children of the age of 6-24 months old, with unilateral uncomplicated, not severe infection. Studies have shown that in this age group most of the AOM will improved without antibiotics, taking this approached will decrease the antibiotics side effects and resistance rate.
In this age group and infants younger than 6 MO, Antibiotics are considered for bilateral infections, or for severe AOM. Penicillin’s drug family are first-line medication, for children with allergies to penicillin, 2do generation cephalosporin is a good alternative choice.
Children younger than 2 years should be treated for 10 days, children aged 2 to 5 years should be treated for at least 7 days, and children 6 years old and older should be treated for 5 to 7 days.
Tympanostomy tube insertion or Ear tubes, when are indicated?
- Bilateral otitis media with effusion (OME) lasting at least 3 months associated with conductive hearing loss
- Bilateral or unilateral otitis media with effusion (OME) lasting at least 3 months associated with risk factors for speech, language, or learning problems.
- Bilateral or unilateral otitis media with effusion (OME) lasting at least 3 months together with symptoms or conditions such as pain, vestibular problems, tympanic membrane damage, or middle ear damage
- Recurrent AOM with OME at the time of assessment
Risk Factors of the procedure include:
- Anesthesia-related risks.
- Tympanic membrane damage.
- Focal atrophy.
Tympanostomy tubes that remain in place longer than 3 years are not likely to spontaneously extrude; they are a risk for chronic perforation of the tympanic membrane. These tubes should be surgically removed.