Acute Middle Ear Infection (Middle Ear Infections)

Acute Middle Ear Infection (Acute Otitis Media) – Treatment Options

Introduction
Acute otitis media (AOM) is an infection of the middle ear, most commonly affecting children, though it can occur in all age groups. It typically follows an upper respiratory tract infection due to eustachian tube dysfunction. Common pathogens include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Clinical features include ear pain, fever, irritability, hearing loss, and in some cases, otorrhea from tympanic membrane perforation. Treatment depends on age, severity, and recurrence.

1. General and Supportive Measures

• Analgesia and antipyretics:

  • Acetaminophen or ibuprofen for pain and fever.

• Observation (“watchful waiting”):

  • In selected children >2 years with mild symptoms and no complications, observation for 48–72 hours before antibiotics.

2. Antibiotic Therapy

• First-line:

  • Amoxicillin (80–90 mg/kg/day in divided doses for children; 500–875 mg every 8–12 hours for adults).

• Second-line/alternative (if amoxicillin failure or recent use):

  • Amoxicillin–clavulanate.

• Penicillin allergy:

  • Macrolides (azithromycin, clarithromycin).

  • Clindamycin in resistant S. pneumoniae.

• Duration:

  • 10 days for children <2 years or severe disease.

  • 5–7 days for older children and adults with mild/moderate disease.

3. Adjunctive and Procedural Management

• Myringotomy: For severe otalgia or complications with effusion under pressure.

• Tympanostomy tubes: In children with recurrent AOM (≥3 episodes in 6 months or ≥4 episodes in 12 months).

• Decongestants/antihistamines: Not recommended routinely (little benefit).

4. Complication Management

• Mastoiditis: IV antibiotics ± mastoidectomy.

• Tympanic membrane perforation: Usually heals spontaneously; persistent perforations may require surgical repair.

• Intracranial complications (rare): Meningitis, brain abscess, venous sinus thrombosis—require urgent intervention.

5. Lifestyle and Preventive Measures

• Vaccinations:

  • Pneumococcal conjugate vaccine (PCV13).

  • Annual influenza vaccine.

• Breastfeeding: Reduces incidence in infants.

• Avoidance of risk factors: Tobacco smoke exposure, bottle-feeding in supine position, and daycare crowding.

6. Multidisciplinary Care

• Primary care/pediatricians: For diagnosis and first-line management.

• Otolaryngologists (ENT): For recurrent AOM, complications, or surgical interventions.

• Audiologists: For children with persistent effusion and risk of hearing loss.