Acute otitis media (AOM) is a common middle ear inflammation often related to viral upper respiratory infections, particularly in children under five. Risk factors include eustachian tube dysfunction, allergies, and exposure to smoke, with primary symptoms including ear pain, fever, and hearing loss. Treatment may involve antibiotics, pain management, and preventive measures such as vaccinations and avoiding risk factors.

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Acute otitis media
Author: Edžus Urtāns
Mentor: Dr.Uldis Urtāns

2.  Acute inflammation in middle ear
 < 3 weeks (month)
 Often associated with a viral upper
respiratory infection
 Most common reason for medical therapy
for children younger than 5 years
 Recurrent otitis media:
 At least 4 episodes/ year
 At least 3 episodes/ 6 months
(with adequate therapy)
Acute otitis media

3.  Most children have at least one episode of
AOM (by age 3, 50-85%)
 Peak incidence age 6-15 months
 Increased incidence in the fall and winter
 Only 20% are adults
 >700 milion cases/year
Epidemiology

4.  Eustachian tube is lined with respiratory
mucosa
 Responds together with nasopharynx
mucosa
 Edema > narrowed > negative middle
lumen ear pressure
 Influx of pathogens from nasopharynx is
possible
Causes

5. Causes
 Inflammatory response in middle ear worsens
the obstruction
 Trigger:
 Allergies
 Upper respiratory tract infections
 GER (especially children)
 Adenoid hypertrophy
 Other

6.  Viral (30-70%)
 RSV
 Rhinovirus
 Coronavirus
 Influenza, parainfluenza
 Bacterial (55%)
 Streptococcus pneumoniae (44%)
 Haemophilus influenzae (41%)
 Moraxella catarrhalis (14%)
 Gram negative enteric bacteria
 S. Aureus
• Combined (15%)
Causes

7.  Age: <7
 Their Eustachian tubes are short, floppy,
horizontal and poorly functioning
Risk factors

8. Handbook of Pediatric Otolaryngology : A Practical Guide for Evaluation and Management
of Pediatric Ear, Nose, and Throat Disorders

9. Risk factors
 Genetic predisposition
 Eustachian tube dysfunction
 Allergic tendencies
 Bottle feeding (first 3 months)
(breast milk contains lactoferrin, oligosaccharide
and surface immunoglobulin A that inhibit
bacterial colonization)
(sucking generates negative pressure)
 Incorrect posture while breastfeeding

10. Risk factors
 Underlying pathology
 Unrepaired cleft palate
 Parental smoking
 Large familys/attending daycare
 Immunocompromised states

11.  Otalgia (not always)
 Fever
 Hearing loss
(speech delay for children)
 Headache
 Nausea
 Cough
 Rhinitis
 Conjunctivitis
Signs and symptoms

12.  Pneumatic otoscopy/otoscopy:
 Red or opaque eardrum
 Retracted eardrum
 Immobile or hypo-mobile eardrum
 Presence of fluid behind eardrum
(purulent, serous, mucoid)
 Retraction pockets
 Bullous myringitis
Physical Examination

15.  Otorrhea (in case of
tympanostomy tube, perforation)
 Mastoid tenderness
 Anteriorly rotated pinna
 Tympanometry
 Audiometry
 Inspection or pharynx and
nasal cavity
Physical Examination

16. Diagnosis
 Acute onset of signs and syptoms
 The presence of middle ear effusion
(hypomobile eardrum, air-fluid level)
 Signs and symptoms of middle ear inflamation
(erythema, otalgia)

17.  Acute mastoiditis
 Abscess formation
 Facial paralysis
 Otitis media with effusion
 Persistent AOM
 Recurrent AOM
 Hearing loss
 Perforation of eardrum
Complications

18. Complications (rare)
 Lateral sinus thrombosis
 Otitic hydrocephalus
 Septic shock
 Meningitis
 Encephalitis
 Extradural abscess
 Labyrinthitis

19.  Antibacterial therapy for:
 Children of age <6months
 6 months to 2 years with severe illness
 Recurrent or billateral AOM
 Immunocompromised patients
 Patients with a perforated tympanic membrane
 Pain management (Ibuprofen, Diclofenac,
paracetamol)
 Decongestants and/or antihistamines,
nasal steroids
Treatment

20. After 24-48h (48-72h)
 If no improvemants:
 No antibiotics > antibiotics
 Antibiotics > change to a different antibiotics

21. Antibacterial therapy
 Amoxicilin 750-1500mg/day 50-100 mg/kg/day
(has not recived amoxicilin in past 30 days and has no
allergy to penicilin)
 Amoxicillin-clavulanate 875/125mg/day
90/6.4 mg/kg/day
(alternative for amoxicilin)
 Ceftriaxone 1-2g/day 50mg/kg/day or
Cefuroxim 500mg/day 30mg/kg/day
 Azithromycin, clarithromycin, erythromycin in
case of allergy to penicilin
 5-7-10 days

22. Recurrent AOM treatment
 +Tympanostomy

23. Non-drug Treatment
 Myringotomy in case of sevare pain
 Tympanocentesis in case of severe pain and as
a diagnostic procedure if there is no
improvement with
2nd line of antibiotics
(local anesthesia)
(narcosis)

24.  Avoiding risk factors if possible
 Vaccination: ?
 S. Pneumonia (PCV-7)
 Influenza
• Adenoidectomy
• Polipectomy
Preventive measures

25. Differential diagnosis
 Otitis externa
 Impacted cerumen or foreign body in ear
 Tympanosclerosis
 Otitis media with effusion
 Injury of the ear

26. Quiz (1)
Two most common bacterial causes of AOM:
A. Haemophilus influenzae, S. Aureus;
B. Moraxella catarrhalis , E. Coli;
C. S. Pneumonia, Haemophilus influenzae;
D. S. Pneumonia, Moraxella catarrhalis

27. Quiz (2)
Recurrent AOM means:
A. At least 5 episodes of AOM a year;
B. At least 8 episodes of AOM till age of 5 years ;
C. At least 3 episodes of AOM in 6 months;
D. At least 2 episodes of AOM in a month

28. Quiz (3)
What can’t be seen in otoscopy of AOM patient:
A. Retracted eardrum;
B. Perforation of eardrum;
C. Bubbles behind eardrum;
D. Bullose myringitis
E. All of above can be seen

29. Quiz (4)
What is always necessary to treat AOM:
(more then one answer is possible)
A. Antibiotics;
B. Analgetics;
C. Tympanostomy;
D. Tea;
E. None from above

30.  Shapiro, Nina L. Handbook Of Pediatric Otolaryngology : A Practical
Guide For Evaluation And Management Of Pediatric Ear, Nose, And
Throat Disorders. Singapore: World Scientific Publishing Company,
2012. eBook Academic Collection (EBSCOhost). Web. 5 Mar. 2016.
 https://www.clinicalkey.com.db.rsu.lv/#!/content/medical_topic/21-s2.0-
1014193?scrollTo=%23heading0
 http://web.a.ebscohost.com.db.rsu.lv/dynamed/detail?vid=2&sid=74b4f
a24-4f97-43f1-a411-
581c0fcc826e%40sessionmgr4003&hid=4204&bdata=JnNpdGU9ZHlu
YW1lZC1saXZlJnNjb3BlPXNpdGU%3d#AN=116345&db=dme
 https://www.clinicalkey.com.db.rsu.lv/#!/content/book/3-s2.0-
B9780323079327000247?scrollTo=%23hl0001072
 https://www.clinicalkey.com.db.rsu.lv/#!/content/book/3-s2.0-
B9780323280471005540
 http://www.aafp.org/afp/2007/1201/p1650.html
 http://journals.plos.org/plosone/article?id=10.1371/journal.pone.00362
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 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC153141/
Sources

31. Thank you for your attention!
(and sorry for terrible english)