Otitis Media: Explained | Cincinnati Children's

https://www.cimcinnatichildrens.com

Matt Smith, MD: Thanks for joining us today. My name is Matt Smith and I’m one of the Pediatric Otolaryngologists here at Cincinnati Children’s Hospital. I’m going to talk to you today about otitis media. It’s surprising but up to 90% of kids by the age of 5 will have an episode of otitis media. Annually 2 million children are diagnosed with otitis media in the United States. Here at CCHMC, within our division of Otolaryngology, we perform approximately 3,600 ear tubes every year for kids that have otitis media.

When seeing kids in clinic with otitis media it’s important to delineate between chronic otitis media with effusion or recurrent acute otitis media as these entities are treated differently. Kids that have chronic otitis media with effusion typically do not present with fever. But instead present with ear pain and a middle ear effusion that does not clear.

The middle ear effusion will be serous or mucoid, typically not purulent. For a recurrent acute otitis media kids do present with fever. They also will present with ear pain and a purulent middle ear effusion. Sometimes the ear drum will be red as well. When diagnosing either entity it is important to perform a proper history and physical.

On the physical exam it’s important to look in the ear and specifically address the movement of the ear drum. Is there middle ear effusion present? It might be purulent, which would suggest recurrent acute otitis media. Or it might be mucoid or serous which would suggest chronic otitis media with effusion. You want to perform pneumatic otoscopy in order to assess the movement of the eardrum itself.

If you don’t have that available but do have tympanometry available that is recommended by our American Academy of Otolaryngology-Head and Neck Surgeons. On physical exam if you notice a tympanic membrane perforation persistent middle ear effusion that’s lasting longer then 3 months, cholesteatoma or signs of mastoiditis, which would include a red and swollen mastoid. Any of these red flags should prompt a referral to an ENT specialist.

The treatment for each of these entities is different that’s why it’s important to delineate between the two. For chronic otitis media with effusion antibiotics are not recommended. Proper pain control and making sure that the effusion clears is the most important thing to do for these children. For recurrent acute otitis media antibiotics are the mainstay in treatment. First line would be high-dose Amoxicillin or Augmentin. If patients are penicillin sensitive then Cephalosporins are definitely a good choice. If patients have a severe penicillin allergy then azithromycin or clindamycin would be recommended.

If kids have failed multiple treatments of antibiotics it might be worthwhile to perform IM Rocephin shots. If we’re getting to that point that’s a reason to refer to an ENT specialist as well.

Thanks again for joining us today if there are any further questions or concerns please feel free to reach out to us through our divisional email [email protected]. and you should receive a response back from a clinician within 24 to 48 hours. If you need prompt response please use the priority number to contact our ENT physician on call. Thanks again.