Otitis Media in Children: Experts' Observations

12 Oct, 11

Otitis Media in Children: Experts' Observations

Otitis media remains the most common infection for which children receive antibiotics. Drawing on systematic reviews of the published literature, a group of leading "ear experts" offers the following observations:

Breast-feeding is protective against Acute Otitis Media (AOM).
Daycare outside of the home, parental smoking, and pacifier use increase the risk for AOM.
It is important to ensure that a child has MEE before diagnosing AOM. Middle Ear Effusion (MEE) is a prerequisite for the diagnosis of both AOM and Otitis Media with Effusion (OME); pneumatic otoscopy offers excellent sensitivity and specificity for detecting MEE.
Although AOM resolves spontaneously in about 80% of older children, this rate is substantially lower in children younger than 2 years.
Children younger than 2 years with a firm diagnosis of AOM should be treated with antibiotics, as antibiotic therapy confers significant benefit in this age group.
For older children who are relatively well (low-grade fever, little pain) or children who have an unclear diagnosis, it is less certain how much benefit antibiotics offer, and these children can probably be observed rather than treated.
Antibiotic treatment should last 7 to 10 days in young children and 5 to 10 days in older children.
Children with AOM who do not receive antibiotics should still receive adequate analgesia for 24 to 48 hours.
It is difficult to demonstrate improved language development in children with recurrent AOM or OME who receive tympanostomy lubes, but tubes certainly reduce the likelihood of MEE and improve hearing in children with hearing deficits.
Surgery to prevent middle ear disease should be considered in the context of the individual child. Recurrent ear disease and hearing loss, poor language development, and an unfavorable home environment all should lower the threshold for surgery.
Children with recurrent ear disease and hearing loss who are at risk for poor language development should be considered candidates for surgery.
Initial surgery to prevent recurrent disease should include myringotomy and tympanostomy tubes; repeat surgery should include myringotomy and adenoidectomy, with or without tubes.

Lancet 2004; 363:465-73.