Acute Otitis Media

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Scott gives us a review of the key pearls from CorePendium's chapter, "Acute Otitis Media."

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Richard L. S. -

You are sending the kid home still crying. Doing house calls in Vail noting a crying child keeping everyone up in a hyatt penthouse and expecting to get paid required something in addition. So I learned about afrin or neosynephrine dripped its the nose with open the Eus tube within 5 min 90% of the time and all happily go to sleep as crying ceases. So treat most crying kids with otitis with drops of a nasal decongestant to stop crying and usually also treat the disease without AB. Send parents home with the remaining bottle used in the ED as you can's anymore use on anyone else and have them do the treatment each 10-12 hours x two more doses and if not successful, then fill AB RX also given. About 70% of the time, no antibiotics are necessary at least so I have experienced for the last 30 years since I learned this method R Stennes

@skobner -

Richard,

Thanks for sharing your experience! You have me jealous about getting to enjoy some house calls in Vail. While I am certainly no expert in the AOM literature, I know there have been some studies demonstrating that there is likely no benefit to nasal or oral decongestants in treatment of AOM--though a Cochrane review article in 2007 was withdrawn that examined all of this data. Currently, the American Academy of Pediatrics does not endorse the routine use of these therapies, but the literature here is lacking! Though we sometimes use oxymetazoline off-label in kids less than 6 years of age, it's important to note that it is not FDA approved for this age group.

For others who might be interested, here is the AAP clinical practice guideline on AOM: https://publications.aap.org/pediatrics/article/131/3/e964/30912/The-Diagnosis-and-Management-of-Acute-Otitis-Media

Here's the AAP Clinical Report on oxymetazoline:
https://publications.aap.org/pediatrics/article/148/5/e2021054271/181367/Topical-Nasal-Decongestant-Oxymetazoline-Safety

As for antibiotics--totally agree. Following the AAP guidelines and the approach laid out here for who to treat, antibiotics can often be delayed for the watch and see approach as we know many of these cases are viral in etiology.

Thanks for the comment and sharing your valuable clinical experiences!
Scott

Miguel M. -

What happen to high-dose amoxicillin (90mg/kg)?

@skobner -

Miguel,

Thanks for the comment! 90 mg/kg per day is the correct dose, at 1:39 I mention this as “45 mg/kg twice a day.”

Hope this helps,
Scott

John C. -

In the ED, I have instilled a few drops of 2 % lidocaine into the ear canal. Most of the pain seems to come from the TM being stretched so often this relieves it and allows the Advil or Tylenol to kick in.
I have found this to be effective most of the time. What are your thoughts?

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