Otitis Media Guidelines

Updated: Mar 19, 2018
  • Author: Muhammad Waseem, MBBS, MS, FAAP, FACEP, FAHA; Chief Editor: Ravindhra G Elluru, MD, PhD  more...
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AAP/AAFP Guidelines for Acute Otitis Media

In February 2013, the American Academy of Pediatrics (AAP) and the American Academy of Family Practice (AAFP) published updated guidelines for the medical management of AOM. [24]  Their recommendations are summarized as follows:

  • AOM management should include pain evaluation and treatment
  • Antibiotics should be prescribed for bilateral or unilateral AOM in children aged at least 6 months with severe signs or symptoms (moderate or severe otalgia or otalgia for 48 hours or longer or temperature 39°C or higher) and for nonsevere, bilateral AOM in children aged 6-23 months
  • On the basis of joint decision-making with the parents, unilateral, nonsevere AOM in children aged 6-23 months or nonsevere AOM in older children may be managed either with antibiotics or with close follow-up and withholding antibiotics unless the child worsens or does not improve within 48-72 hours of symptom onset
  • Amoxicillin is the antibiotic of choice unless the child received it within 30 days, has concurrent purulent conjunctivitis, or is allergic to penicillin; in these cases, clinicians should prescribe an antibiotic with additional beta-lactamase coverage
  • Clinicians should reevaluate a child whose symptoms have worsened or not responded to the initial antibiotic treatment within 48-72 hours and change treatment if indicated
  • In children with recurrent AOM, tympanostomy tubes (TTs), but not prophylactic antibiotics, may be indicated to reduce the frequency of AOM episodes
  • Clinicians should recommend pneumococcal conjugate vaccine and annual influenza vaccine to all children according to updated schedules
  • Clinicians should encourage exclusive breastfeeding for 6 months or longer

AAO-HNSF/AAP/AAFP Guidelines for Otitis Media With Effusion

In February 2016, the American Academy of Otolaryngology–Head and Neck Surgery Foundation, the AAP, and the AAFP issued the following updated guidelines for OME [29] :

  • The clinician should perform pneumatic otoscopy to assess for OME in a child with otalgia, hearing loss, or both
  • Clinicians should obtain tympanometry in children with suspected OME for whom the diagnosis is uncertain after performing (or attempting) pneumatic otoscopy
  • Clinicians should evaluate at-risk children for OME at the time of diagnosis of an at-risk condition and at 12 to 18 months of age (if diagnosed as being at risk prior to this time)
  • Clinicians should not routinely screen children for OME who are not at risk and do not have symptoms that may be attributable to OME, such as hearing difficulties, balance (vestibular) problems, poor school performance, behavioral problems, or ear discomfort
  • Clinicians should manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known) or 3 months from the date of diagnosis (if onset is unknown)
  • Clinicians should recommend against using intranasal steroids or systemic steroids for treating OME
  • Clinicians should recommend against using systemic antibiotics for treating OME
  • Clinicians should recommend against using antihistamines, decongestants, or both for treating OME
  • Clinicians should obtain an age-appropriate hearing test if OME persists for 3 months or longer  or for OME of any duration in an at-risk child
  • Clinicians should reevaluate, at 3- to 6-month intervals, children with chronic OME until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected
  • Clinicians should recommend tympanostomy tubes when surgery is performed for OME in a child younger than 4 years; adenoidectomy should not be performed unless a distinct indication (eg, nasal obstruction, chronic adenoiditis) exists other than OME
  • Clinicians should recommend tympanostomy tubes, adenoidectomy, or both when surgery is performed for OME in a child aged 4 years or older