Case Challenge: Acute Otitis Media in Children--Best Management Strategies

Gordon H. Sun, MD, MS


March 28, 2018

Management of Severe AOM

The AAP guideline for AOM management[1] classifies AOM as "severe" in the presence of moderate or severe otalgia of ≥ 48 hours' duration or temperature ≥ 39˚ C. For children aged 6 months and older, severe AOM should be treated with antibiotic therapy—typically amoxicillin if the patient is not penicillin-allergic, has not received the medication in the past 30 days, or does not have concurrent purulent conjunctivitis. Tympanostomy tube placement is a consideration for patients with major sequelae of otitis media, such as mastoiditis, meningitis, or facial nerve paralysis.

Recurrent AOM

A 7-year-old boy with no known medical problems or drug allergies was brought to his pediatrician by his parents. He was successfully treated for ear infections with antibiotics three times in the past 6 months, most recently about 2 months ago. The patient said that he had a hard time hearing his teachers in class. Pneumatic otoscopy demonstrated brownish MEE bilaterally but no other otologic findings. Neurologic exam was unremarkable other than evidence of bilateral conductive hearing loss on 512 Hz tuning fork testing. Audiologic testing confirmed mild conductive hearing loss and flat tympanograms (type B) binaurally. The patient was diagnosed with bilateral otitis media with effusion.


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