Ear Infection and Antibiotic in Children

Ear Infection and Antibiotic in Children

Ear Infection in Children

Otitis media is the second most common reason after the common cold for visits to the doctor and the most frequent reason for prescribing antibiotics to children.

About 90% of children have OME (Otitis Media with effusion) at some time before school age and 75% of children have at least one episode of AOM (Acute Otitis Media) by the age of 2 years which usually resolves spontaneously Appropriate treatment of children with “ear infection” requires distinguishing AOM from OME by careful history and pneumatic otoscopic examination (single most important tool).

Ear Infection and Antibiotic in Children

Some definitions:

Acute otitis media (AOM): an acute bacterial infection of the middle ear of fewer than 6 weeks duration.

Chronic suppurative otitis media (CSOM): If ear drum infection persists for more than 3 months and is associated with a chronic perforation of the tympanic membrane.

Otitis media with effusion (OME): Fluid in the middle ear without signs or symptoms of inflammation. It can occur just prior to AOM or persist after AOM for a few days or up to many weeks.

So How Do We Diagnose Ear Infection? Distinguishing OME and AOM

  • No ear pain
  • No draining ear.
  • Slight hearing impairment/ear blockade.
  • History of frequent URTI & mouth breathing

Examination of Ear by ENT specialist: with an otoscope - TM pulled, air bubbles may be seen.

Tympanometry test may show c or B Read More

  • Usually healthy child
  • Sudden onset ear pain, blocked ear feeling
  • Fever, h/o common cold /stuffy nose
  • Pus from ear if ear drum ruptures.

Ear Examination by ENT Specialist

Congested, dull drum with / w/o discharge

Hole in the eardrum may be seen

Audiometry: mild to moderate conductive hearing loss.

Tympanogram may show type “B” curve

How to Treat Ear Infection in Children (AOM and OME)?

Treatment for children with OME

Usually resolves without treatment for 3 months it is just wait and watch
Hearing testing is done.

If the effusion persists for more than 3 months and/or hearing loss exceeds 20 dB surgery is required, tympanostomy tube (Grommet) Read More insertion is done.

Adenoidectomy is done if indication for surgery is present.
Treatment for Children with acute otitis media-(Antibiotic use in ear infection in children)
As per The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) guidelines.

Uncomplicated AOM in an otherwise healthy child above 2 years of age is given analgesics for pain, nasal drops, and antihistamines.

If there is no response to 2-3 days antibiotic is to be started.
Antibiotics should be prescribed if child is
Tympanic membrane perforation in children usually heals spontaneously in 1-2 months. During this time water entry in the ears should be avoided and all possible preventive measure to reduce chances of catching a common cold is to be taken.

Surgical management of otitis media is indicated for recurrent AOM, AOM with complications, chronic suppurative otitis media (CSOM) and otitis media with effusion where chances of hearing and speech problem are predicted. Read More
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