Otology

➡️Introduction and definitions

Acute otitis media (AOM) is defined as the presence of inflammation in the middle ear cleft with an ‎effusion. The onset of symptoms and signs is rapid. It should be differentiated from otitis media with ‎effusion (OME)‎ ¹

Otitis media with effusion OME; inflammation of the middle ear with fluid collected in the middle ear and ‎absence of signs and symptoms of acute infection.‎ ²

Middle ear effusion MEE; liquid in the middle ear without reference to etiology, pathogenesis, pathology, or ‎duration ²

Persistent otitis; Persistence or worsening of symptoms after the initial management ³

Recurrent otitis media; three or more documented and separate episodes of AOM within 6 months or four ‎or more episodes within 12 months with at least one episode in the past 6 months.‎ ⁴

Uncomplicated AOM; AOM without otorrhoea ⁵

Non-severe AOM; AOM with the presence of mild otalgia and a temperature below 39°C ⁶

Severe AOM; AOM with the presence of moderate to severe otalgia or fever equal to or higher than 39°C ⁶

Tympanometry; measuring acoustic immittance (transfer of acoustic energy) of the ear as a function of ‎ear canal air pressure ⁷

Initial antibiotic therapy; treatment of AOM with antibiotics that are prescribed at the time of diagnosis with ‎the intent of starting antibiotic therapy as soon as possible after the encounter ⁸

Initial observation; initial management of AOM limited to symptomatic relief, with commencement of ‎antibiotic therapy only if the child’s condition worsens at any time or does not show clinical improvement ‎within 48 to 72 hours of diagnosis.‎ ⁹

➡️Purpose

The main goal of this guideline is to establish uniformity in the assessment and management of children ‎with acute otitis media. ‎

To reach a proper diagnosis of AOM and exclude other causes of pain and hearing loss in children. Direct to ‎proper management, and advise when to prescribe the proper antibiotic if and when needed, to improve ‎the quality of life of our patients.‎

The primary outcome of interest was the total antibiotic prescription incidence for AOM. Secondary ‎outcomes included the type of antibiotic prescribed and the prescription of analgesics.‎

➡️Scope:

The scope of the guideline is the diagnosis and management of AOM and recurrent AOM in children ‎‎6 months and older without any underlying conditions.‎

The guideline also aims at recommending the different ways of preventing recurrence of AOM.‎

➡️Target audience:

ENT, Pediatricians and family physicians, to be used for management and/or ‎appropriate referral of children with acute otitis media. ‎