Otitis Media 3 months–12 years

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.

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.

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
  • Diagnostic Criteria:
    • 3+ separate episodes of AOM in 6 mo,
    • 4+ separate episodes of AOM in 12 mo, or
    • 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.
  • Order: "Refer to Audiology Internal"

Resources/References

• Lieberthal, A. et al. The Diagnosis and Management of Acute Otitis Media. Pediatrics. March 2013, 131(3)e964-e999; doi.org/10.1542/peds.2012-3488
• Singleton, R. et al. Trends in otitis media and myringtomy with tube placement among American Indian/Alaska native children and the US general population of children. Pediatr Infect Dis J. 2009 Feb;28(2):102-7. doi: 10.1097/INF.0b013e318188d079
• Ochi, J. et al. Chronic Otitis Media in Ancient American Indians. Pediatrics. 2018; 141(4):e20172308
• Coleman, A. et al. The unsolved problem of otitis media in indigenous populations: a systematic review of upper respiratory and middle ear microbiology in indigenous children with otitis media. Microbiome 6, 199 (2018). https://doi.org/10.1186/s40168-018-0577-2
• Otitis Media 2019 (PowerPoint Presentation)
• Otitis Media (Powerpoint presentation by Dr. Leslie Herrmann)
• The Draining Ear 2017 (Powerpoint Presentation)
• Otitis Media (PowerPoint Presentation)
• ENT Guidelines 2015 (Powerpoint Presentation)
• ANMC Pediatric Acute Otitis Media Clinical Guideline
• Acute Otitis Media (3 months to 12 years) YKHC Clinical Guideline

YKHC Clinical Guidelines
Common/Unique Medical Diagnoses