The evaluation and management of acute otitis media in children

Abstract

Otitis media is one of the most common pediatric diseases, which occurs in approximately 7 of 10 children and affhcts all ages, races, and social groups. Acute otitis media (AOM) is the most common specific diagnosis made by pediatricians,’ accounting for up to one third of all pediatric outpatient visits.*y3 It has been estimated that in the United States AOM accounts for more than 11 million physician-visits annually by children younger than 5 years and more than 2 billion dollars in annual health care costs. Approximately one fourth of all medications prescribed are for the treatment of AOM,4 and myringotomy with insertion of tympanostomy tubes is the most commonly performed surgical procedure in children requiring general anesthesia. It is important that physicians providing care for children are thoroughly familiar with the clinical entity of AOM. because accurate diagnosis and timely therapy can augment resolution of AOM and prevent complications. Some of the goals in managing pediatric AOM are to expediently resolve the acute episode, prevent recurrent episodes, hasten middle ear effusion (MEE) resolution, normalize and maintain normal hearing, and avoid any long-term impairment of speech, language, and cognitive development. There are a number of excellent studies that define various aspects of this disease. Accurate comparison of study results can be difftcult at times because of methodological variation, ie, differing diagnostic criteria for AOM, and biases in patient sampling, ie, clinic-based versus population-based studies. The purpose of this article is to review aspects of the large body of medical literature related to the evaluation and management of AOM. Other aspects related to the topic of pediatric otitis media, eg, the medical and surgical management of recurrent and chronic middle ear disease, are discussed elsewhere.