OTITIS MEDIA IN CHILDREN

Nauvaldi Sasongkojati (30101206698)

Otitis media is one of a number of factors causing physicians to seek out the
most cost-effective clinical strategies for managing the condition.
Antibiotic
Insidensi Cost
encourages

the emergence of multidrug-resistant strains of

bacterial pathogens
 DEFINITION
 An inflammation of the middle ear

OTOSKOPI
SIGN SYMPT COMPLICATION
FINDING
Complication
• pain, • decreased • Damage to the
• fever, mobility of the structures of the
Otoscopic finding • anorexia, tympanic middle ear
membrane, (retraction
• Vomiting
(bulging contour pockets,
cz the visibility adhesions,
Onset of the ossicular perforations,
landmarks is ossicular
impaired; erosion, and
Symptoms. • a yellow/red cholesteatoma)
color (or both);
• Exudate &
bullae
 A child without symptoms, the tympanic membrane appears opaque,
thickened, and scarred, it is difficult to distinguish cute otitis media from
otitis media with effusion.

• clinical signs and symptoms

OMA that is • otoscopic findings of inflammation
unresponsive to • --continue beyond 48 hours of therapy.
treatment
• an asymptomatic
• without otoscopic signs of inflammation
Otitis media with • --3 to 16 weeks after the diagnosis of acute otitis.
residual effusion

• can be considered otitis media with

After 16 persistent effusion.
weeks
Bacterial pathogens
 Streptococcus pneumoniae
 Haemophilus influenzae (pathogens most frequently associated
with sinusitis and pneumonia)
 Moraxella catarrhalis,
 Strep. pyogenes,
 Staph- ylococcus aureus,
 Gram-negative enteric bacteria, and
 Anaerobes.
Antibiotics
 Amoxicillin, trimethroprim plus
sulfamethoxazole, and
erythromycin plus sulfisoxazole
are the antibiotics used initially for
acute otitis media
 Pain usually continues for 8 to 24 hours after the
initiation of antibiotic treatment. The most common
treatment of pain, analgesics 
ACETAMINOPHEN/IBUPROFEN is often effective
 Other options are topical eardrops  benzocaine,
glycerin, and antipyrine

 Topical therapy should be avoided when the eardrum has

ruptured or is likely to rupture, because of the possibility
of damaging middle-ear tissue.
 Trimethoprim–sulfamethoxazole
and erythromycin + sulfisoxazole
cover most b -lactamase–
producing organisms resistant
to amoxicillin
age<15 months
 Third-generation cephalosporins
and amoxicillin+clavulanate are
mainly useful as antibiotics for
children who are allergic either to
amoxicillin or to antibiotics a history of recurrent
containing sulfa. in the child or a
 If there is concern about associated sibling
bacteremia or about patient
compliance, a child can be treated
with an IM ceftriaxone
 Follow-up visits for children with risk antibiotic treatment
factors for treatment failure should take of otitis media within
place 2-6 weeks after the initiation of the previous month
therapy.
 Tympanocentesis should be performed if the
patient appears to have sepsis
 If unresponsive acute otitis media persist after a
second or third course of antibiotics,
myringotomi or tympanocentesis may be
reasonable option in order to isolate the
pathogen, drain the effusion, and identify the
sensitivity patternof the organism
 RECURRENT ACUTE OTITIS MEDIA
 Can be considered to exist when three new episodes of the
condition occur within a 6-month period.
 The administration of antibiotics at the onset of symptoms of
upper respiratory infection, rather than daily continuous
prophylaxis, can also prevent episodes of otitis.
 Antibiotic prophylaxis for 3-6 months can be recommended as
the initial approach to the prevention of episodes of recurrent
otitis
 Active immunization it is reasonable to immunize children
who have recurrent otitis with influenza vaccine and, in
children over two years of age, with the pneumococcal vaccine
(Pneumovax)
 OTITIS MEDIA WITH RESIDUAL EFFUSION

The management remains present for a period of 6 weeks to 4 months

antibiotic and a
observation Antibiotics
corticosteroid

Several meta-analyses reports  treatment with an antibiotic + a

corticosteroid was more effective

corticosteroid (prednisone, 1 along with an antibiotic

mg/Kg/BB/day, given orally in 2 (trimethoprim–sulfamethoxazole or
doses) for 7 days an alternative) for 14 to 21 days
 • increased appetite, fluid retention, occasional
vomiting, and, in rare cases, marked changes in
side effects behavior
of prednisone

• If the residual middleear effusion  the child

followed should be followed up monthly.
up

• Antibiotic prophylaxis with low doses of amoxicillin (20

mg/Kg/day, given either once or twice daily) or sulfisoxazole
(75 mg/Kg/day, given either once or twice daily) should be
low doses administered for 3 months to prevent a recurrence
 OM WITH PERSISTENT EFFUSION
• have a higher incidence of abnormalities cholesteatoma,
adhesive otitis, retraction pockets, atrophy of the tympanic
membrane, and persistent membrane perforations than
complication children without a history of persistent effusion

• The main reason for surgery  placement of

ventilating tubes and adenoidectomy
surgery

• cannot be recommended for children <4 years of age

• only if a child has a complication from ventilating tubes (persistent
otorrhea or intrusion of a tube into the middle-ear space, or if the
contraindication patient requires multiple reinsertions of the tubes)
CONCLUTION
The diagnosis and management of otitis media
in children remain challenging and
controversial

clinician to solicit and to consider parental

preferences in treatment.