Otitis Media 3 months–12 years - Revision history

LiamG at 21:28, 5 August 2025

2025-08-05T21:28:09Z

JenniferH at 17:41, 27 October 2021

2021-10-27T17:41:55Z

← Older revision		Revision as of 17:41, 27 October 2021
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	Please refer to our Otitis Media Guideline (see link below in Resources/References). If the TMs are red and have no mobility – then recommendation is to treat them as suggested by ~~ENT or~~ the primary care provider (Many ENTs prefer monitoring even if TMs are red and immobile). Our antibiotic recommendation include—first line high dose Amoxicillin, second line Augmentin, third line Omnicef, and lastly Rocephin x 3 days. Referral to audiology is always warranted and recommended if the child has history of ear infections. (ENT always wants an audiogram regardless of number of ear infections). Tube placement referral is very common and is performed in Anchorage.		Please refer to our Otitis Media Guideline (see link below in Resources/References). If the TMs are red and have no mobility – then recommendation is to treat them as suggested by the primary care provider or ENT (Many ENTs prefer monitoring even if TMs are red and immobile). Our antibiotic recommendation include—first line high dose Amoxicillin, second line Augmentin, third line Omnicef, and lastly Rocephin x 3 days. Referral to audiology is always warranted and recommended if the child has history of ear infections. (ENT always wants an audiogram regardless of number of ear infections). Tube placement referral is very common and is performed in Anchorage.

	~~Many people have had mastoiditis and had mastoidectomies~~ in ~~our population~~. ~~They should~~ be ~~seen by ENT every 1-–2 years to have their mastoid bowls cleaned out and examined~~.		In general, children should be referred to Audiology at YKHC for recurrent infections (>3 in 6 months or 4 in a year), persistent effusion >3 months (especially with hearing loss), or if there is a question of hearing loss/speech delay secondary to recurring infections. Audiologists routinely do telemedicine consults with the ANMC ENT’s using TM photos. Antibiotic prophylaxis for recurrent OM’s is not warranted as this has not been shown to be effective.

	~~In general, children should be direct referred to ENT for PE tube placement if they~~ have ~~recurrent (>3 in 6 months or 4~~ in ~~a year) infections or persistent effusion >3 months (especially with hearing loss)~~. ~~You may also refer~~ these patients ~~to audiology if there is a question of hearing loss/speech delay secondary to recurring infections; this is another route to ENT care as the audiologists routinely do telemedicine consults~~ with ~~the ANMC ENT’s using TM photos. We no longer do antibiotic prophylaxis for recurrent OM’s,~~ as ~~this has not been shown to be effective~~. '''All infants fewer than 3 months of age that are diagnosed by a CHA to have otitis media should be seen and evaluated in Bethel before being started on any antibiotic.'''		Many people have had acute otitis media complicated by mastoiditis requiring mastoidectomies in our population. We encourage ENT be consulted for these patients with treatment and follow up as ENT recommends.

			'''All infants fewer than 3 months of age that are diagnosed by a CHA to have otitis media should be seen and evaluated in Bethel before being started on any antibiotic.'''

	*Recurrent Acute Otitis Media that qualifies for ear tubes		*Recurrent Acute Otitis Media that qualifies for ear tubes
	**Order: "Refer to Audiology Internal"
	**Diagnostic Criteria:		**Diagnostic Criteria:
	***3+ separate episodes of AOM in 6 mo,		***3+ separate episodes of AOM in 6 mo,
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	***OME present for 3+ months		***OME present for 3+ months
	***''If these criteria are not met, but you have concerns about hearing or other complications associated with recurrent AOM, please place order for hearing screen through Audiology who can direct to ENT as needed.''		***''If these criteria are not met, but you have concerns about hearing or other complications associated with recurrent AOM, please place order for hearing screen through Audiology who can direct to ENT as needed.''
	****Order: "Refer to Audiology Internal"		**Order: "Refer to Audiology Internal"

	===Resources/References===		===Resources/References===

JenniferH at 18:16, 26 October 2021

2021-10-26T18:16:54Z

← Older revision		Revision as of 18:16, 26 October 2021
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	*Recurrent Acute Otitis Media that qualifies for ear tubes		*Recurrent Acute Otitis Media that qualifies for ear tubes
	**Order: "Refer to Audiology Internal"		**Order: "Refer to Audiology Internal"
	*Diagnostic Criteria:		**Diagnostic Criteria:
	**3+ separate episodes of AOM in 6 mo,		***3+ separate episodes of AOM in 6 mo,
	**4+ separate episodes of AOM in 12 mo, or		***4+ separate episodes of AOM in 12 mo, or
	**OME present for 3+ months		***OME present for 3+ months
	**If these criteria are not met, but you have concerns about hearing or other complications associated with recurrent AOM, please place order for hearing screen through Audiology who can direct to ENT as needed.		***''If these criteria are not met, but you have concerns about hearing or other complications associated with recurrent AOM, please place order for hearing screen through Audiology who can direct to ENT as needed.''
	***Order: "Refer to Audiology Internal"		****Order: "Refer to Audiology Internal"

	===Resources/References===		===Resources/References===

JenniferH at 18:15, 26 October 2021

2021-10-26T18:15:07Z

← Older revision		Revision as of 18:15, 26 October 2021
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	In general, children should be direct referred to ENT for PE tube placement if they have recurrent (>3 in 6 months or 4 in a year) infections or persistent effusion >3 months (especially with hearing loss). You may also refer these patients to audiology if there is a question of hearing loss/speech delay secondary to recurring infections; this is another route to ENT care as the audiologists routinely do telemedicine consults with the ANMC ENT’s using TM photos. We no longer do antibiotic prophylaxis for recurrent OM’s, as this has not been shown to be effective. '''All infants fewer than 3 months of age that are diagnosed by a CHA to have otitis media should be seen and evaluated in Bethel before being started on any antibiotic.'''		In general, children should be direct referred to ENT for PE tube placement if they have recurrent (>3 in 6 months or 4 in a year) infections or persistent effusion >3 months (especially with hearing loss). You may also refer these patients to audiology if there is a question of hearing loss/speech delay secondary to recurring infections; this is another route to ENT care as the audiologists routinely do telemedicine consults with the ANMC ENT’s using TM photos. We no longer do antibiotic prophylaxis for recurrent OM’s, as this has not been shown to be effective. '''All infants fewer than 3 months of age that are diagnosed by a CHA to have otitis media should be seen and evaluated in Bethel before being started on any antibiotic.'''

	*~~(The ENT external referral~~ for ear tubes ~~no longer exists). As of now all ear related problems go through audiology unless the patient just so happens to be in Anchorage for another appt.~~		*Recurrent Acute Otitis Media that qualifies for ear tubes
	**Order: "Refer to Audiology Internal"		**Order: "Refer to Audiology Internal"
	*Diagnostic Criteria:		*Diagnostic Criteria:
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	**4+ separate episodes of AOM in 12 mo, or		**4+ separate episodes of AOM in 12 mo, or
	**OME present for 3+ months		**OME present for 3+ months
	**If these criteria are not met, but you have concerns about hearing or other complications associated with AOM, please place order for hearing screen through Audiology who can direct to ENT as needed.		**If these criteria are not met, but you have concerns about hearing or other complications associated with recurrent AOM, please place order for hearing screen through Audiology who can direct to ENT as needed.
	***Order: "Refer to Audiology Internal"		***Order: "Refer to Audiology Internal"

JenniferH at 18:32, 28 September 2021

2021-09-28T18:32:38Z

← Older revision		Revision as of 18:32, 28 September 2021
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	*(The ENT external referral for ear tubes no longer exists). As of now all ear related problems go through audiology unless the patient just so happens to be in Anchorage for another appt.		*(The ENT external referral for ear tubes no longer exists). As of now all ear related problems go through audiology unless the patient just so happens to be in Anchorage for another appt.
	**Order: "Refer to Audiology Internal"		**Order: "Refer to Audiology Internal"
	**Diagnostic Criteria:		*Diagnostic Criteria:
	***3+ separate episodes of AOM in 6 mo,		**3+ separate episodes of AOM in 6 mo,
	***4+ separate episodes of AOM in 12 mo, or		**4+ separate episodes of AOM in 12 mo, or
	***OME present for 3+ months		**OME present for 3+ months
	**If these criteria are not met, but you have concerns about hearing or other complications associated with AOM, please place order for hearing screen through Audiology who can direct to ENT as needed.		**If these criteria are not met, but you have concerns about hearing or other complications associated with AOM, please place order for hearing screen through Audiology who can direct to ENT as needed.
	***Order: "Refer to Audiology Internal"		***Order: "Refer to Audiology Internal"

JenniferH at 18:27, 28 September 2021

2021-09-28T18:27:43Z

← Older revision		Revision as of 18:27, 28 September 2021
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	~~Lots and lots on the Delta.~~ Please refer to our Otitis Media Guideline (see link below in Resources/References). If the TMs are red and have no mobility – then recommendation is to treat them. Our antibiotic recommendation include—first line high dose Amoxicillin, second line Augmentin, third line Omnicef, and lastly Rocephin x 3 days. If the child has ~~a long~~ history of ear infections ~~– referral for audiology for hearing eval~~ . Tube placement referral is very common ~~– it~~ is ~~done~~ in Anchorage.		Please refer to our Otitis Media Guideline (see link below in Resources/References). If the TMs are red and have no mobility – then recommendation is to treat them as suggested by ENT or the primary care provider (Many ENTs prefer monitoring even if TMs are red and immobile). Our antibiotic recommendation include—first line high dose Amoxicillin, second line Augmentin, third line Omnicef, and lastly Rocephin x 3 days. Referral to audiology is always warranted and recommended if the child has history of ear infections. (ENT always wants an audiogram regardless of number of ear infections). Tube placement referral is very common and is performed in Anchorage.

	Many people ~~over the last few decades~~ had mastoiditis and had mastoidectomies ~~to treat it~~ in our population. They should be seen by ENT every 1-–2 years to have their mastoid bowls cleaned out and examined.		Many people have had mastoiditis and had mastoidectomies in our population. They should be seen by ENT every 1-–2 years to have their mastoid bowls cleaned out and examined.

	In general, children should be direct referred to ENT for PE tube placement if they have recurrent (>3 in 6 months or 4 in a year) infections or persistent effusion >3 months (especially with hearing loss). You may also refer these patients to audiology if there is a question of hearing loss/speech delay secondary to recurring infections; this is another route to ENT care as the audiologists routinely do telemedicine consults with the ANMC ENT’s using TM photos. We no longer do antibiotic prophylaxis for recurrent OM’s, as this has not been shown to be effective. '''All infants fewer than 3 months of age that are diagnosed by a CHA to have otitis media should be seen and evaluated in Bethel before being started on any antibiotic.'''		In general, children should be direct referred to ENT for PE tube placement if they have recurrent (>3 in 6 months or 4 in a year) infections or persistent effusion >3 months (especially with hearing loss). You may also refer these patients to audiology if there is a question of hearing loss/speech delay secondary to recurring infections; this is another route to ENT care as the audiologists routinely do telemedicine consults with the ANMC ENT’s using TM photos. We no longer do antibiotic prophylaxis for recurrent OM’s, as this has not been shown to be effective. '''All infants fewer than 3 months of age that are diagnosed by a CHA to have otitis media should be seen and evaluated in Bethel before being started on any antibiotic.'''

	* ~~Patients can be directly referred to~~ ENT for PE tubes ~~if family agrees~~.		*(The ENT external referral for ear tubes no longer exists). As of now all ear related problems go through audiology unless the patient just so happens to be in Anchorage for another appt.
	**Order: "Refer to ~~ENT External~~"		**Order: "Refer to Audiology Internal"
	**Parent must desire procedure in the next 4 weeks
	**Diagnostic Criteria:		**Diagnostic Criteria:
	***3+ separate episodes of AOM in 6 mo,		***3+ separate episodes of AOM in 6 mo,

JenniferH at 21:34, 20 August 2021

2021-08-20T21:34:41Z

← Older revision		Revision as of 21:34, 20 August 2021
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	* Patients can be directly referred to ENT for PE tubes if family agrees.		* Patients can be directly referred to ENT for PE tubes if family agrees.
	**Order: "Refer to ENT External~~-Ear Tube(s)~~"		**Order: "Refer to ENT External"
	**Parent must desire procedure in the next 4 weeks		**Parent must desire procedure in the next 4 weeks
	**Diagnostic Criteria:		**Diagnostic Criteria:

JenniferH at 23:11, 24 February 2021

2021-02-24T23:11:39Z

← Older revision		Revision as of 23:11, 24 February 2021
Line 1:		Line 1:
	Lots and lots on the Delta. Please refer to our ~~[[Acute Otitis Media 3 months –12 years\|~~Otitis Media Guideline]]. If the TMs are red and have no mobility – then recommendation is to treat them. Our antibiotic recommendation include—first line high dose Amoxicillin, second line Augmentin, third line Omnicef, and lastly Rocephin x 3 days. If the child has a long history of ear infections – referral for audiology for hearing eval . Tube placement referral is very common – it is done in Anchorage.		Lots and lots on the Delta. Please refer to our Otitis Media Guideline (see link below in Resources/References). If the TMs are red and have no mobility – then recommendation is to treat them. Our antibiotic recommendation include—first line high dose Amoxicillin, second line Augmentin, third line Omnicef, and lastly Rocephin x 3 days. If the child has a long history of ear infections – referral for audiology for hearing eval . Tube placement referral is very common – it is done in Anchorage.

	Many people over the last few decades had mastoiditis and had mastoidectomies to treat it in our population. They should be seen by ENT every 1-–2 years to have their mastoid bowls cleaned out and examined.		Many people over the last few decades had mastoiditis and had mastoidectomies to treat it in our population. They should be seen by ENT every 1-–2 years to have their mastoid bowls cleaned out and examined.

JenniferH: /* Resources/References */

2021-02-02T01:36:05Z

Resources/References

← Older revision		Revision as of 01:36, 2 February 2021
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	* [[media:OM update.pdf\|Otitis Media]] (PowerPoint Presentation)		* [[media:OM update.pdf\|Otitis Media]] (PowerPoint Presentation)
	* [[media:ENT Guidelines.pdf\|ENT Guidelines 2015]] (Powerpoint Presentation)		* [[media:ENT Guidelines.pdf\|ENT Guidelines 2015]] (Powerpoint Presentation)
			* [https://anmc.org/files/OtitisMedia.pdf ANMC Pediatric Acute Otitis Media Clinical Guideline]
	* [[media:AOM_peds.pdf\|Acute Otitis Media (3 months to 12 years) YKHC Clinical Guideline]]		* [[media:AOM_peds.pdf\|Acute Otitis Media (3 months to 12 years) YKHC Clinical Guideline]]

JenniferH at 08:42, 20 November 2020

2020-11-20T08:42:20Z

← Older revision		Revision as of 08:42, 20 November 2020
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	* [[media:AOM_peds.pdf\|Acute Otitis Media (3 months to 12 years) YKHC Clinical Guideline]]		* [[media:AOM_peds.pdf\|Acute Otitis Media (3 months to 12 years) YKHC Clinical Guideline]]

	[[:category:YKHC Guidelines]]
			[[:category:YKHC Guidelines\|YKHC Clinical Guidelines]]
	<br/>[[Practicing Medicine in Bush Alaska—Some ABCs\|Common/Unique Medical Diagnoses]]		<br/>[[Practicing Medicine in Bush Alaska—Some ABCs\|Common/Unique Medical Diagnoses]]

← Older revision		Revision as of 01:36, 2 February 2021
Line 25:		Line 25:
	* [[media:OM update.pdf\|Otitis Media]] (PowerPoint Presentation)		* [[media:OM update.pdf\|Otitis Media]] (PowerPoint Presentation)
	* [[media:ENT Guidelines.pdf\|ENT Guidelines 2015]] (Powerpoint Presentation)		* [[media:ENT Guidelines.pdf\|ENT Guidelines 2015]] (Powerpoint Presentation)
			* [https://anmc.org/files/OtitisMedia.pdf ANMC Pediatric Acute Otitis Media Clinical Guideline]
	* [[media:AOM_peds.pdf\|Acute Otitis Media (3 months to 12 years) YKHC Clinical Guideline]]		* [[media:AOM_peds.pdf\|Acute Otitis Media (3 months to 12 years) YKHC Clinical Guideline]]