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How is acute middle ear infection or inflammation treated?

The treatment for acute otitis media varies depending upon the age and symptoms of the child. The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) recommend the following:

AAP and AAFP Recommendations
Age Certain Diagnosis Uncertain Diagnosis
<6 months Antibiotics Antibiotics
6 months-2years Antibiotics Antibiotics if severe illness; *Observation without antibiotics option if non-severe illness
≥2 years Antibiotics if severe illness; *Observation option if non-severe illness *Observation option without antibiotics

*Observation is an appropriate option only when follow-up can be ensured and antibacterial agents can be started if symptoms persist or worsen. Non-severe illness is represented by mild ear pain and fever <39 C (102.2 F) in the past 24 hours. Severe illness is moderate to severe otalgia (ear pain) or fever 39 C.

If antibiotics are initiated, amoxicillin is usually recommended as the first line treatment. This is usually prescribed for 10 days. About 10% of children do not respond within the first 48-72 hours of treatment, and antibiotic therapy may have to be changed. Even after antibiotic treatment, 40% of children are left with some fluid in the middle ear which can cause temporary hearing loss lasting for up to 3 to 6 weeks. In most children, this fluid eventually disappears spontaneously (on its own). Ceftriaxone (50mg/kg/d) injection is recommended for children that cannot take oral antibiotics; three days of this antibiotic is usually more effective than a single injection.

Children who have recurring bouts of otitis media may be referred to an otolaryngologist (ear nose and throat specialist or ENT). Some of these children may benefit from having an ear tube placed (tympanostomy tube

) to permit fluid to drain from the middle ear. In addition, if a child has a bulging eardrum and is experiencing severe pain, a procedure to lance the eardrum (myringotomy) may be recommended to release the pus. The eardrum usually heals within a week.

Date: 2015-04-20; view: 630


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