Internal Medicine

0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

Otitis Media 1121

■Behavioral audiometry for younger children; acoustic audiometry

for older children/adults

■CT scan with contrast if complications of OM (cranial neuropathy,

brain abscess, etc.) are suspected

■Tympanocentesis to determine microbiology in refractory cases of

COM

differential diagnosis

n/a

management

n/a

specific therapy

Treatment Options

■Antibiotics:

➣Amoxicillin, cefaclor, amoxicillin-clavulanate, trimethoprim-

sulfamethoxazole, erythromycin-sulfisoxazole, cefixime, cefuro-

xime axetil

■Prophylaxis:

➣S pneumoniae vaccination, chronic prophylactic antibiotics

➣Tympanostomy tubes for recurrent otitis media (5 episodes/y)

or 3+mo of OME

➣Adenoidectomy+/−tonsillectomy with tubes

Side Effects

■Drug allergies

■Tympanostomy tubes: otorrhea & recurrent infection due to retro-

grade flow of water into middle ear; pt must keep ears dry

■Adenoidectomy/tonsillectomy: acute bleeding, velopharyngeal in-

sufficiency (VPI)

follow-up

■7–10 d of antibiotics for AOM; follow-up in 1–2 wk

■Surveillance to 3 mo if effusion persists; then tympanostomy tubes

indicated; refer to otolaryngologist.

■If any complications from OM such as vertigo, facial nerve weakness,

sensorineural hearing loss, cholesteatoma, TM perforation, retrac-

tion pocket, or other abnormality, refer to specialist.

■If >3 episodes of AOM in 6 mo or >4 episodes/y, refer to specialist.