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Acute Otitis Media (AOM)
Conservative Management
Many patients with AOM can be treated conservatively, which includes:
Outpatient observation and surveillance of symptoms for 48-72 hours.
Oral analgesia such as Acetaminophen and Ibuprofen.
Antibiotic Treatment
Systemic antibiotic therapy in AOM is recommended to relieve symptoms and reduce the risk of complications in young infants and patients with severe infections.
In adults, antibiotics are typically given to prevent complications.
Amoxicillin is the first line agent in antibiotic-naïve patients. A macrolide can be given if the patient is severely allergic to penicillin.
Figure 1
Figure 1: Table showing an example of an antibiotic regime used for the treatment of acute otitis media
Surgical Management
Indications
Not routinely indicated in acute AOM.
For patients with treatment failure or recurrent infection.
Procedures
Myringotomy
Surgical incision into the tympanic membrane to drain fluid to relieve pressure/pain.
Considered as an adjunct to antibiotic therapy for severe otalgia and a bulging tympanic membrane.
Myringotomy with tympanostomy tube insertion
Placement of small tubes into the tympanic membrane to prevent the accumulation of fluid.
Considered for otitis media with effusion and in children with recurrent AOM.
Myringotomy with tympanostomy tube insertion
Otitis Media with Effusion (OME)
Management of OME is largely conservative; patients are referred to ENT for consideration of surgery if there is hearing loss or an increased risk of developmental delay.
Conservative Management
Perform pneumatic otoscopy and hearing tests every 3-6 months.
Consider the use of an auto-inflation device. This is to increase the nasal pressure, thus keeping the eustachian tube open.
If hearing is impaired, strategies to facilitate the child’s understanding and learning should be implemented.
Steroids, antibiotics, antihistamines, anti-reflux therapies and decongestants are not routinely indicated for the treatment of OME.
Surgical Management
Indications
Chronic OME with any of the following characteristics:
Hearing loss
Damage to the TM
Risk factors for developmental disorders in children with OME
Procedures
Patients < 4 years of age: tympanostomy tube placement
Patients > 4 years of age: tympanostomy tube placement and/or adenoidectomy
Follow-up: Repeat hearing test to confirm hearing loss has improved
Chronic Suppurative Otitis Media
Conservative Management
Indications
Tubo-tympanic CSOM.
Post-tympanostomy tube CSOM.
Preferred Conservative Management
Usually determined in consultation with otolaryngology
Topical antibiotic (usually a fluroquinolone e.g. Ofloxacin or Ciprofloxacin) with/without a topical steroid.
Aural toilet
Suspected fungal infection: Add a topical antifungal in consultation with ID.
Alternative
Oral antibiotics.
Topical antiseptics.
Surgical Management
Indications
Atti-coantral CSOM.
Recurrent or persistent CSOM.
Any associated urgent complications of CSOM.
Procedures
Tympanoplasty with or without mastoidectomy.
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