Ear Infections (Otitis Media) in Children

Description

Alternative Names

Treatment

Experts continue to argue about the best approach for treating ear infections. The major debates rest on the use of antibiotics, surgery, and watchful waiting in both acute otitis media (AOM) and otitis media with effusion (OME). Treatments for ear infections cost the country between three and four billion dollars each year, and many of these treatments, particularly heavy antibiotic use and surgical procedures, are often unnecessary in many children.

Treatment Guidelines for Acute Otitis Media (AOM)

In 2004, the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) released updated guidelines for the management and diagnosis of acute otitis media.

These guidelines include the following recommendations:

• Accurate diagnosis of AOM including differentiation from OME.
• Children less than 6 months of age should receive immediate antibiotic treatment.
• Children 6 months or older should be treated for pain within the first 24 hours with either acetaminophen or ibuprofen.
• An initial observation period of 48 to 72 hours is recommended for select children to determine if the infection will resolve on its own without antibiotic treatment. (Most children do improve within 72 hours.)
• For children aged 6 months to 2 years, criteria for recommending an observation period are an uncertain diagnosis of AOM and a determination that the AOM is not severe. For children older than 2 years, the observation period criteria are non-severe symptoms or uncertain diagnosis. Severe AOM symptoms include moderate to severe pain and a fever of at least 102.2 degrees (39 degrees Celsius).
• If antibiotics are needed, amoxicillin is recommended as first-line treatment (except in children who are allergic to penicillins).

Treatment Guidelines for Otitis Media with Effusion (OME)

In 2004, the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) released updated clinical practice guidelines for OME. These guidelines include the following treatment recommendations:

Watchful Waiting. The child is typically monitored for the first three months. Antibiotics are not helpful for most patients with OME. For one, the condition resolves without treatment in nearly all children, especially those whose OME followed an acute ear infection. Approximately 75 to 90 percent of OME cases that result from AOM resolve within three months. If OME last longer than 3 months, a hearing test should be conducted. Even if OME lasts for longer than 3 months, the condition may resolve on its own and intervention may not be necessary. The physician will re-evaluate the child at periodic intervals to determine if there is risk for hearing loss.

Drug Treatment. Antibiotics and corticosteroids have not proven to be of long-term benefit and are not recommended for routine management of OME. Antihistamines and decongestants are not effective for OME, either used alone or in combination. At present, there is no compelling evidence to indicate that allergy treatment can assist with OME management nor has a causal relationship between allergies and OME been established.

Surgery. Children may be considered candidates for surgery if they have:

• OME lasting longer than 4 months that is accompanied by hearing loss.
• OME that is persistent or recurrent (even if there is no hearing loss) and may put the child at risk for developmental delays or structural damage to the ear.
• OME and structural damage to the eardrum or middle ear.

The decision to pursue surgery must be determined on an individual basis.

• Tympanostomy tube insertion is the first choice for surgical intervention. Approximately 20 to 50 percent of children who undergo this procedure may have OME relapse and require additional surgery.
• Adenoidectomy plus myringotomy, with or without tube insertion, is recommended as a repeat surgical procedure. Tube insertion may be advised for children younger than 4 years of age.
• Adenoidectomy is not recommended as an initial procedure unless some other condition (chronic sinusitis, nasal obstruction, adenoiditis) is present.
• Neither myringotomy alone or tonsillectomy is recommended for OME treatment.