ALERTS
- Mastoiditis
- Perforated TM
- Persistent or recurrent OM
AGE CONSIDERATIONS
- Otitis Media: infant, toddler >school age, adolescent
DIFFERENTIAL DIAGNOSIS
- Ear foreign body
- Otitis Externa
- Otitis Media
- Parotitis
- Referred pain from oropharynx or teeth
- Temporomandibular joint pain
EVALUATION
HISTORY
- Onset and quality of pain, associated fever, URI, ear drainage, ear trauma, recent activities (i.e. swimming)
PHYSICAL EXAM
- HEENT: otoscopic findings, oropharynx, dentition
DIAGNOSTIC FINDINGS
- Ear: Tympanic membrane findings: Position, erythema, effusion, mobility, light reflex, perforation
- Pinna: assess for pain with traction, foreign body, laceration
CONCERNING FINDINGS
- Mastoiditis: proptosis of the ear, swelling or erythema over the mastoid
- Parotitis: swelling anterior and/or inferior to the ear
DIAGNOSTIC TESTS
Diagnostic Procedures
- Pneumatic otoscopy
MANAGEMENT
TRANSFER/ADMISSION CONSIDERATIONS
- Mastoiditis
- Suppurative parotitis
- Ear foreign body of organic material
- Deeper ear canal foreign body
- Laceration to the auricle involving cartilage
OTITIS MEDIA
Treatment
First Line
- Otitis media with intact TM: Amoxicillin (80-90 mg/kg divided BID for 10 days)
- Otitis media with tympanostomy tubes: Ofloxacin or Ciprodex
- Otitis media with perforation should be treated with oral and topical antibiotics
Second Line
- Augmentin (80-90 mg/kg of amoxicillin component divided BID for 10 days). Use high dose formulation only
- Azithromycin
Supportive
- Fever and pain reliever
Complementary & Alternative Therapies
- Xylitol may play a role in prevention
- Antihistamine or over the counter cold remedies are not recommended
Surgery / Other Procedures
- Persistent effusion may require tympanostomy
Follow Up
Outpatient Referral
- Follow up in 10-14 days for reevaluation, sooner with persistent symptoms
- Consider specialist for persistent effusion, recurrent infections
Anticipatory Guidance
- May take 24-48 hours for symptoms relief after starting antibiotics
Signs and Symptoms to return
- Persistent fever, ear drainage
- Ear swelling, proptosis, mastoid tenderness or erythema
PROGNOSIS, COMPLICATIONS
- Mastoiditis
- Otitis Media with perforation
Otitis Externa
Treatment
First Line
- Topical antibiotic drops: Cortosporin
- Consider wick placement for significant debris to improve delivery of drops
Second Line
- Ciprodex or Ofloxacin
Supportive
- Pain reliever
- Avoid swimming or use ear plugs until treatment is completed
FOLLOW UP
Outpatient Referral
- Resistant/Persistent infections may be mycotic, refer to Ear, Nose and Throat specialist
Anticipatory Guidance
- Pain reliever
- Pain may persist for 1-2 days affter treatment is started
- Preventative measures with OTC swimmers ear drops have unknown benefit
Activity, Diet
- Refrain from swimming or use ear plugs until therapy is complete
Signs and Symptoms to return
- Worsening or persistent ear pain
PROGNOSIS, COMPLICATIONS
- Fever is rare and should prompt concern for complications
- Cellulitis of the Pinna can develop if untreated
EAR FOREIGN BODY (CANAL)
see Procedures
EAR FOREIGN BODY (SOFT TISSUE)
see Procedures
REFERENCES
1
2
ADDITIONAL RESOURCES
- AAP Otitis Media