Acute Otitis Media

  • Presentation:
    • Decreased hearing
    • Pain that is unaffected by movement of the outer ear (otitis externa causes pain with external ear movement)
    • Associated systemic signs of infection such as fever or malaise
    • Otitis media generally causes a dulling of sound, but hearing is still present. Complete hearing loss is more common with auditory canal occlusion (foreign body, cerumen) and sometimes with otitis externa
    • A mobile TM suggests that no fluid is present in the middle ear and that the diagnosis of otitis media cannot be made.
    • With an examination of the tympanic membrane for acute otitis media, the most useful positive findings include a bulging or cloudy TM (due to effusion), bulging of the TM, and a loss of TM mobility
  • Risk Factors:
    • Age < 2 years
    • Male
    • Genetic predisposition
    • Previous episode(s) of otitis media
    • Cigarette smoking in the household
    • Attendance at daycare
    • Recent upper respiratory infection
  • Treatment:
    • First Line
      • Amoxicillin: 80 mg/kg split at least BID X at least 5 days
      • SMX-­‐‑TMP: 40 mg/kg SMX and 8 mg/kg TMP divided BID X 10 days à avoid in patients
        with Sulfa allergy, G6PD deficiency; light sensitivity possible
    • Second Line
      • Ceftriaxone: 50 mg/kg up to 1 g
      • Amoxicillin-­‐‑clavulanate: 20-­‐‑45 mg/day of amoxicillin component in 2 or 3 doses
      • Azithromycin: 30 mg/kg as a single dose OR 10 mg/kg QD x 3 days OR 10 mg/kg X 1 day
        then 5 mg/kg on days 2-­‐‑5
    • Prophylaxis for recurrent AOM
      • Amoxicillin: half daily dosage at bedtime
      • SMX-­‐‑TMP: 40 mg/kg SMX and 8 mg/kg TMP QHS

Acute Otitis Externa

  • Treatment:
    • Ciprodex Otic Solution
    • 1) Neomycin Solutions:
      • 3-­4 drops QID X 7 days 
      • Adverse effects include rupture of the tympanic membrane, potential ototoxicity with ruptured TM
    • 2) Ofloxacin Solutions:
      • for children 1-­12 years, use 5 drops BID X 10 days;
      • for patients ≥12 years old, use 10 drops BID X 10 days
    • Neomycin, Polymyxin B, and Hydrocortisone otic drops
  • Swimmer’s Ear:
    • Swimmers ear is a form of recurrent or chronic otitis externa caused by chronic irritant fluid accumulation in the acoustic canal, such as can occur in competitive swimmers.
    • Often, this is more of inflammatory etiology than infective
    • The use of topical astringent drops, such as acetic acid, sometimes combined with topical steroids such as hydrocortisone are effective along with efforts to clear water from the canal when drying off.