Ver el código de «Acute otitis media»

==Background==
[[File:Gray907.png|thumb|Ear anatomy]]
[[File:Otitis Media.png|thumb|Anatomy of acute otitis media.]]
[[File:Otitis media.jpg|thumb|Schematic showing association with Eustachian tube.]]
*Peak incidence: 6-18 months of age
* 2nd most common cause of ED visits after URI

===Etiology===
*Viral (70% of cases)
*Bacterial
**[[S. pneumo]] (50%)
**Nontypable [[H. flu]] (30%)
**[[Moraxella]] (30%)

==Clinical Features==
[[File:Otitis media entdifferenziert2.jpg|thumb|A bulging tympanic membrane which is typical in a case of acute otitis media]]
[[File:Otitis media grippe.jpg|thumb|Another patient with bulging and erythematous tympanic membrane consistent with acute otitis media.]]
*Symptoms typically include [[Earache|ear pain]], [[fever]]
*Acute onset (<48hr) AND
*Middle ear effusion AND
*Signs of middle ear inflammation
**Middle Ear Effusion: bulging TM, impaired TM movement, otorrhea, or air/fluid level 
**Middle Ear inflammation: erythema of TM or otalgia

==Differential Diagnosis==
{{Ear DDX}}

===Less common===
*Oral cavity disease (referred pain)
*Cholesteatoma
*[[PTA]]
*[[Brain abscess]]
*[[Lemierre's Syndrome]]
*[[Herpes zoster oticus]]

{{Pediatric fever DDX}}

==Evaluation==
*Typically clinical
*Erythema alone not enough to diagnose
*Other clinical features: acute onset pain, bulging TM, opacified TM/loss of landmarks, otorrhea

==Management==
===[[Analgesia]]===
*[[Acetaminophen]]/[[ibuprofen]] and topical [[benzocaine]] (unless [[perforated TM]])

===[[Antibiotics]]===
===2013 AAP Decision to Treat Guidelines<ref>AAP Clinical Practice Guideline The Diagnosis and Management of Acute Otitis Media http://pediatrics.aappublications.org/content/early/2013/02/20/peds.2012-3488.full.pdf </ref>===
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''Age'''
| align="center" style="background:#f0f0f0;"|'''Otorrhea'''
| align="center" style="background:#f0f0f0;"|'''Severe Symptoms^'''
| align="center" style="background:#f0f0f0;"|'''Bilateral without Otorrhea'''
| align="center" style="background:#f0f0f0;"|'''Unilateral without Otorrhea'''
|-
| 6mo-2y||Antibiotics||Antibiotics||Antibiotics||Antibiotics or observation period (wait and see)
|-
| ≥2y||Antibiotics||Antibiotics||Antibiotics or observation period (wait and see)||Antibiotics or observation period (wait and see)
|}
^Severe symptoms = fever > 39C or severe otalgia > 48 hrs

'''Also Consider In:'''
*Age <6mo
*Ill-appearing
*Recurrent acute otitis media (within 2-4wk)
*Concurrent antibiotic treatment
*Other bacterial infections
*Immunocompromised
*Craniofacial abnormalities

====Wait-and-see antibiotic prescription (WASP)====
*Rather that routine prescription is an option to avoid over use if the patient does not meet any of the prescription criteria''<ref>Spiro DM. Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. JAMA. 2006 Sep 13;296(10):1235-41.</ref>
*If symptoms worsen or persist for 48-72 then caretaker fill the prescription
*Fever (relative risk [RR], 2.95; 95% confidence interval [CI], 1.75 - 4.99; P<.001) and otalgia (RR, 1.62; 95% CI, 1.26 - 2.03; P<.001) were associated with filling the prescription in the WASP group

===[[Antibiotics]] Options===
*Consider treating for a standard of 10 days as opposed to a shorter duration of 5 days to reduce treatment failure in young children<ref>Hoberman A et al. Shortened Antimicrobial Treatment for Acute Otitis Media in Young Children. N Engl J Med 2016; 375:2446-2456.</ref>
**Treatment failure for 10 day at 16% and for 5 day at 34% for [[amoxicillin-clavulanate]]
**RTC of 520 children aged 6-23 months
{{Otitis Media Antibiotics}}

==Disposition==
*Outpatient management

==Complications==
*[[Mastoiditis]]
*[[Meningitis]]
*[[Brain Abscess]]
*[[Labyrinthitis]]
*Lateral Venous Sinus Thrombosis

==See Also==
*[[Ear diagnoses]]

==References==
<references/>

[[Category:Pediatrics]]
[[Category:ENT]]
[[Category:ID]]