1. AOM

2. Otitis Media  Otitis Media with effusion (OME)  Acute Otitis Media (AOM)  Recurrent AOM  Chronic Otitis Media/Chronic Otitis Media with effusion  Chronic Suppurative Otitis Media (CSOM)

3. Epidemiology  Seasonal Peak: winter months  90% of children have at least one symptomatic or asymptomatic episode by 2yrs of age  Incidence Peaks: 6-18months of age

4. Risk Factors  Age <2yrs  Atopy  Bottle propping  Chronic sinusitis  Ciliary dysfunction  Cleft palate and craniofacial anomalies  Child Care attendance  Down Syndrome and other genetic conditions

5. Pathogenesis  Impaired eustachian tube function  Negative pressure increases  Nasopharyngeal contents are aspirated into middle ear  Increased vascular permeability: development of MEE

6. Viruses  RSV  Paraflu (types 1,2,3)  Influenza (type A and B)  Adenovirus  Coronavirus

7. Bacteria  Streptococcus Pneumoniae  Nontypeable Hemophilus influenza  Moraxella catarrhalis  S. pyogenes (Group A strep)  Staph Aureus (less common)

8. PE: OME vs AOM  Fluid in middle ear space  AOM: inflammation, specifically otalgia and fever  OME: TM appears opaque or cloudy  AOM: red or dark-yellow discoloration of TM or bulging of TM

9. Normal TM

10. OME

11. AOM

12. Management  Observation  Treatment

13. Management  <6months: antibacterial therapy  6months to 2years with certain diagnosis: antibacterial therapy  6months to 2 years with uncertain diagnosis: antibacterial therapy or observation  2yrs and up with certain diagnosis: antibacterial therapy or observation  2yrs and up with uncertain diagnosis: observation

14. Antibiotic  High dose amoxicillin: 80-90mg/kg/day  Alternative for penicillin allergy  Augmentin 90mg/kg per day of amox component  Ceftriaxone  Clindamycin

15. Complications  Mastoiditis  Acute labyrinthitis  Petrositis  Meningitis  Brain Abscess  Epidural Abscess  Otitic hydrocephalus