Otitis Media 3 months–12 years
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.
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.
- Order: "Refer to ENT External-Ear Tube(s)"
- Parent must desire procedure in the next 4 weeks
- 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"
- 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