A look at this common and controversial topic.


https://media.blubrry.com/coreem/content.blubrry.com/coreem/Acute_Otitis_Media.mp3



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Tags: Pediatrics





Show Notes
Background:

The most common infection seen in pediatrics and the most common reason these kids receive antibiotics
The release of the PCV (pneumococcal conjugate vaccine), or Prevnar vaccine, has made a big difference since its release in 2000 (Marom 2014)

This, along with more stringent criteria for what we are calling AOM, has led to a significant decrease in the number of cases seen since then
29% reduction in AOM caused by all pneumococcal serotypes among children who received PCV7 before 24 months of age


The peak incidence is between 6 and 18 months of age
Risk factors: winter season, genetic predisposition, day care, low socioeconomic status, males, reduced duration of or no breast feeding, and exposure to tobacco smoke.
The predominant organisms: Streptococcus pneumoniae, non-typable Haemophilus influenzae (NTHi), and Moraxella catarrhalis.

Prevalence rates of infections due to Streptococcus pneumoniae are declining due to widespread use of the Prevnar vaccine while the proportion of Moraxella and NTHi infection increases with NTHi now the most common causative bacterium
Strep pneumo is associated with more severe illness, like worse fevers, otalgia and also increased incidence of complications like mastoiditis.



Diagnosis

The diagnosis of acute otitis media is a clinical one without a gold standard in the ED (tympanocentesis)
Ear pain (+LR 3.0-7.3), or in the preverbal child, ear-tugging or rubbing is going to be the most common symptom but far from universally present in children. Parents may also report fevers, excessive crying, decreased activity,