American Academy of Pediatrics clinical management guidelines, endorsed by the American Academy of Family Physicians, July 2013 (Reaffirmed 2019)
Apply to otherwise healthy children 6 months through 12 years of age.
Recommendations
Diagnosis
- moderate to severe bulging of the tympanic membrane (TM)
- new onset of otorrhea not due to acute otitis externa
- mild bulging of the TM and recent (< 48 hours) onset ear pain or intense erythema of TM
Absence of any middle ear effusion in those children who undergo pneumatic otoscopy (or tympanometry) excludes the diagnosis.
Management
- Relieve suffering: assess and treat for pain [Nurofen is my preference]
- Oral Antibiotic in children 6 months and older with severe signs or symptoms:
- moderate or severe otalgia or otalgia > 48 hours
- temperature ≥ 39°C [102.2°F]
- bilateral AOM in children 6 – 23 months old, even without severe signs or symptoms
- otherwise, either prescribe antibiotic or observe with close follow-up (within 48-72 hours of onset, as required)
- Prescribe Amoxicillin unless:
- child received amoxicillin in the past 30 days
- child has concurrent purulent conjunctivitis
- child is allergic to penicillin
- child has history of recurrent AOM unresponsive to amoxicillin
- Prophylactic antibiotics have no place in management of recurrent AOM. Tympanostomy tubes may be offered if there have been 4 episodes in 1 year (one of which occurred in the last 6 months) or 3 episodes in 6 months.
American Academy of Otolaryngology-Head and Neck Surgeons clinical management guidelines for Otitis Media With Effusion endorsed by the American Academy of Family Physicians, October 2015
- Use Pneumatic otoscopy to diagnose suspected otitis media with effusion (OME) in child with ear pain and/or hearing loss ± Tympanometry if doubt remains.
- Neonates who fail newborn screen need close follow-up after resolution of any OME to exclude an underlying sensorineural hearing loss.
- Evaluate children with baseline sensory, physical, cognitive, or behavioral factors early for hearing, speech, language, and need for intervention including evaluation for OME at time of presentation time and at 12 to 18 months of age. (otherwise, children should not be routinely screened for OME).
- watchful wait for 3 months from date of effusion onset (if known) or date of diagnosis
- Antibiotics, antihistamines, decongestants and/or intranasal or systemic corticosteroids are not indicated in OME
- Hearing test when OME persists ≥ 3 months or at any time that language delay, learning problems, or a significant hearing loss is suspected in a child with OME.
- Re-examine child with chronic OME at 3- to 6-month intervals until either (whichever comes first):
- resolution of effusion
- significant hearing loss identified
- structural abnormalities of eardrum or middle ear suspected
- Counsel families of children with bilateral OME and hearing loss about potential impacts on speech and language development
Available at https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/otitis-media.html.
References
Lieberthal, A. S., et al. (2013). “The Diagnosis and Management of Acute Otitis Media.” Pediatrics 131(3): e964-e999. DOI: https://doi.org/10.1542/peds.2012-3488.
Rosenfeld, Richard M., Jennifer J. Shin, Seth R. Schwartz, Robyn Coggins, Lisa Gagnon, Jesse M. Hackell, David Hoelting, et al. “Clinical Practice Guideline: Otitis Media with Effusion (Update).” Otolaryngology–Head and Neck Surgery 154, no. 1_suppl (February 2016): S1–41. doi:10.1177/0194599815623467.
