Otitis Media 3 months–12 years

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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.

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.

  • (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"
  • 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 AOM, please place order for hearing screen through Audiology who can direct to ENT as needed.
      • Order: "Refer to Audiology Internal"

Resources/References


YKHC Clinical Guidelines
Common/Unique Medical Diagnoses