Clinical Notes : ENT

125. Acute Otitis Media

Children and Young Adults

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Acute Otitis Media

 

All children and young people with acute otitis media

 

  • Be aware that:

    • acute otitis media is a self-limiting infection that mainly affects children

    • acute otitis media can be caused by viruses and bacteria, and it is difficult to distinguish between these (both are often present at the same time)

    • symptoms last for about 3 days, but can last for up to 1 week

    • most children and young people get better within 3 days without antibiotics

    • complications such as mastoiditis are rare.

 

  • Assess and manage children under 5 who present with fever as outlined in the NICE guideline on fever in under 5s.

 

  • Give advice about:

    • the usual course of acute otitis media (about 3 days, can be up to 1 week)

    • managing symptoms, including pain, with self-care.

 

  • Reassess at any time if symptoms worsen rapidly or significantly, taking account of:

    • alternative diagnoses, such as otitis media with effusion (glue ear)

    • any symptoms or signs suggesting a more serious illness or condition

    • previous antibiotic use, which may lead to resistant organisms.

 

Algorithm for the management of acute otitis media

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Children and young people who may be less likely to benefit from antibiotics

 

Consider no antibiotic prescription or a back-up antibiotic prescription,  taking account of:

  • evidence that antibiotics make little difference to symptoms (no improvement in pain at 24 hours, and after that the number of children improving is similar to the number with adverse effects)

  • evidence that antibiotics make little difference to the development of common complications (such as short-term hearing loss [measured by tympanometry], perforated eardrum or recurrent infection)

  • evidence that acute complications such as mastoiditis are rare with or without antibiotics

  • possible adverse effects of antibiotics, particularly diarrhoea and nausea.

 

  • When no antibiotic prescription is given, as well as the general advice, give advice about:

    • an antibiotic not being needed

    • seeking medical help if symptoms worsen rapidly or significantly, do not start to improve after 3 days, or the child or young person becomes systemically very unwell.

 

When a back-up antibiotic prescription is given, as well as the general advice, give advice about:

  • an antibiotic not being needed immediately

  • using the back-up prescription if symptoms do not start to improve within 3 days or if they worsen rapidly or significantly at any time

  • seeking medical help if symptoms worsen rapidly or significantly, or the child or young person becomes systemically very unwell.

 

Children and young people who may be more likely to benefit from antibiotics (those of any age with otorrhoea or those under 2 years with infection in both ears)

  • Consider no antibiotic prescription with advice, a back-up antibiotic prescription with advice or an immediate antibiotic prescription, taking account of:

    • evidence that acute complications such as mastoiditis are rare with or without antibiotics

    • possible adverse effects of antibiotics, particularly diarrhoea and nausea.

 

  • When an immediate antibiotic prescription is given, as well as the general advice, give advice about seeking medical help if symptoms worsen rapidly or significantly, or the child or young person becomes systemically very unwell.

Children and young people who are systemically very unwell, have symptoms and signs of a more serious illness or condition, or are at high-risk of complications

  • Offer an immediate antibiotic prescription with advice, or further appropriate investigation and management.

 

  • Refer children and young people to hospital if they have acute otitis media associated with:

    • a severe systemic infection (see the NICE guideline on sepsis)

    • acute complications, including mastoiditis, meningitis, intracranial abscess, sinus thrombosis or facial nerve paralysis.

 
 

Self-care

  • Offer regular doses of paracetamol or ibuprofen for pain, using the right dose for the age or weight of the child at the right time, and maximum doses for severe pain.

  • Explain that evidence suggests decongestants or antihistamines do not help symptoms.

 
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Treating Your Infection

Patient Information leaflet to be used with patients who are experiencing self limiting URTIs

 

Adapted for use in ROI

From : Treat Antibiotics Responsibly, Guidance, Education, Tools (TARGET) 

Royal College of General Practitioners (RCGP UK)

Access

 

Otitis Media: Antibiotics for children and young people under 18 years

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Summary tables: infections in primary care

Management and treatment of common infections:

guidance for consultation and adaptation

Access

 
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NICE 2018. 

Otitis Media (acute): antimicrobial prescribing. 

March 2018

View/Access

Acute otitis media

BMJ Best Practice

January 2019

Access

Management and treatment of common infections

Public Health England (PHE)

October 2017

Access

Management of acute otitis media in children six months of age and older

Canadian Paediatric Society

Paediatr Child Health 2016;21(1):39-44

Access

Fever in under 5s: assessment and initial management

NICE guidelineCG160

August 2017

Access

Tähtinen PA, Laine MK, Ruohola A.

Prognostic factors for treatment failure in acute otitis media.

Pediatrics. 2017 Sep;140(3):e20170072

Access

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