AOM

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AOM
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Otitis Media

• Otitis Media with effusion (OME)
• Acute Otitis Media (AOM)
• Recurrent AOM
• Chronic Otitis Media/Chronic Otitis Media with
  effusion
• Chronic Suppurative Otitis Media (CSOM)

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Epidemiology

• Seasonal Peak winter months
• 90 of children have at least one symptomatic or
  asymptomatic episode by 2yrs of age
• Incidence Peaks 6-18months of age

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Risk Factors

• Age lt2yrs
• Atopy
• Bottle propping
• Chronic sinusitis
• Ciliary dysfunction
• Cleft palate and craniofacial anomalies
• Child Care attendance
• Down Syndrome and other genetic conditions

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Pathogenesis

• Impaired eustachian tube function
• Negative pressure increases
• Nasopharyngeal contents are aspirated into middle
  ear
• Increased vascular permeability development of
  MEE

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Viruses

• RSV
• Paraflu (types 1,2,3)
• Influenza (type A and B)
• Adenovirus
• Coronavirus

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Bacteria

• Streptococcus Pneumoniae
• Nontypeable Hemophilus influenza
• Moraxella catarrhalis
• S. pyogenes (Group A strep)
• Staph Aureus (less common)

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PE OME vs AOM

• Fluid in middle ear space
• AOM inflammation, specifically otalgia and fever
• OME TM appears opaque or cloudy
• AOM red or dark-yellow discoloration of TM or
  bulging of TM

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Normal TM
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OME
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AOM
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Management

• Observation
• Treatment

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Management

• lt6months antibacterial therapy
• 6months to 2years with certain diagnosis
  antibacterial therapy
• 6months to 2 years with uncertain diagnosis
  antibacterial therapy or observation
• 2yrs and up with certain diagnosis antibacterial
  therapy or observation
• 2yrs and up with uncertain diagnosis observation

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Antibiotic

• High dose amoxicillin 80-90mg/kg/day
• Alternative for penicillin allergy
• Augmentin 90mg/kg per day of amox component
• Ceftriaxone
• Clindamycin

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Complications

• Mastoiditis
• Acute labyrinthitis
• Petrositis
• Meningitis
• Brain Abscess
• Epidural Abscess
• Otitic hydrocephalus