Acute Otitis Media: Diagnosis, Intervention, & Prevention

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Table of Contents

Search Strategy
Case Study
References

Search Strategy

The correct guideline was found in an online National Guideline Clearinghouse database by cross-referencing the name of the condition, and key patient symptoms mentioned in the case such as bilateral ear pain and high temperature. The guideline was developed by the American Academy of Pediatrics (AAP). The group of developers featured 13 members with Doctor of Medicine degrees. This guideline is a 2013 revision of a previously issued document published in 2004 by AAP.

A systematic review of the current best evidence is a type of data collection method that requires a researcher to read, compare, and evaluate data produced by other researchers in the sphere in the latest years (Hoffman, Michel, Rosenfeld, & Davidson, 2012). This method is used to form a well-round understanding and produce an analysis of reliable evidence with implications for practical use.

The document states that all conflicts of interest were resolved through a standard procedure within the AAP. All researchers have filed conflict of interest statements. Since the document was initially developed and consequently reviewed within the same organization, the probability of the conflict of interest seems to be minimal.

The quality of evidence is defined by the type of methods used for data collection. Randomized controlled trials (RCT) are generally accepted as a strong evidence source if they are conducted on relevant populations. The evidence quality of a second grade is an RCT or diagnostic study with insignificant limitations. Third-grade evidence is gained from observational studies such as case-control and cohort research. Expert opinion, reports on cases are considered as evidence of the lowest quality. In the current guideline, the evidence quality ranges from A to C primarily comprised of B-level evidence.

Strong recommendation is the claim of high authority that is based on high-quality evidence. Such a recommendation is made when expected benefits outweigh potential detriments. Clinical workers are advised to follow strong recommendations unless there is a clearly articulated reason against them. A recommendation is issued in similar situations as with strong recommendations but the quality of evidence is lower. The circumstances may obscure the search for highly credible evidence or make it impossible, but if benefits outweigh harms, still a recommendation can be made. An option is a treatment approach that is supported by evidence to an extent that it is equal or similar to another with not enough data to vouch for its recommendation. In doubtful clinical situations, doctors are advised to consider available options to ensure the quality of care is maximal and the bias is minimal. When no recommendation is made, the quality of evidence is usually low and possible harms and benefits are not clearly defined. Such practices should be avoided until hard evidence emerges and the pros and cons become clear.

Key action statements are the interventions identified by researchers in relation to a particular medical condition. Each action statement includes the strength of evidence, benefit-harm correlation, recommendation strength and any relating notes (Flynn et al., 2017). The present guideline includes 6 recommended or highly recommended key action statements with A, B or C-level of evidence. They primarily address the domains of pain management, treatment, and diagnosis.

Case Study

Diagnostics

Acute otitis media (AOM) is diagnosed in children with medium or serious swelling of the tympanic membrane (TM). Additionally, symptoms may include otorrhea, the emergence of pain within the last 48 hours, and TM erythema (Lieberthal et al., 2013).

Medications

Antibiotic therapy is in order in children patients older than 6 months with recent ear pains and temperature above 102.2°F. Amoxicillin is recommended provided the antibiotic treatment is agreed upon. Dosage is 80–90 mg/kg per day in two divided doses. Treatment length is advised to last from five to seven days (Lieberthal et al., 2013). The conditions are that prior to the current incident a patient did not receive it within 30 days or does not have purulent conjunctivitis or an allergy to penicillin. Parallel to amoxicillin, the clinician should prescribe β-lactamase coverage (6.4 mg/kg/day) if the amoxicillin administered within 30 days had no effect or a patient has purulent conjunctivitis. Treatment length of five to seven days is considered sufficient (Hoberman et al., 2016). Prophylactic antibiotics should be avoided in children with periodical AOM.

Follow-up

After two or three days of initial antibiotic treatment, a first follow-up is in order. If positive changes occur, the treatment should follow the regular procedure for Otitis Media treatment. An additional follow-up visit may be scheduled in two weeks after successful treatment (Kujala et al., 2012). Should any symptoms of AOM occur, parents might request additional visits.

Referral

If AOM reoccurs, a referral to an otolaryngologist is in order (van de Pol et al., 2013).

Prevention

Annual vaccination against influenza and the pneumococcal conjugate vaccine is encouraged for reducing the risk of recurrent AOM. Avoidance of tobacco smoke inhalation is also considered a benefit.

Pain Control

Acetaminophen or ibuprofen is advised for mild or moderate pain. These medication choices are strongly recommended. The effect might be limited and additional pain management might be needed.

References

Flynn, J. T., Kaelber, D. C., Baker-Smith, C. M., Blowey, D., Carroll, A. E., Daniels, S. R.,… Gidding, S. S. (2017). Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics, 140(3), e20171904.

Hoberman, A., Paradise, J. L., Rockette, H. E., Kearney, D. H., Bhatnagar, S., Shope, T. R., … Shaikh, N. (2016). Shortened antimicrobial treatment for acute otitis media in young children. The New England Journal of Medicine, 375(25), 2446–2456.

Hoffman, R. N., Michel, G., Rosenfeld, R. M., & Davidson, C. (2012). Building better guidelines with BRIDGE-Wiz: Development and evaluation of a software assistant to promote clarity, transparency, and implementability. Journal of the American Medical Informatics Association, 19(1), 94–101.

Kujala, T., Alho, O. P., Luotonen, J., Kristo, A., Uhari, M., Renko, M.,… Koivunen, P. (2012). Tympanostomy with and without adenoidectomy for the prevention of recurrences of acute otitis media: A randomized controlled trial. The Pediatric Infectious Disease Journal, 31(6), 565-569.

Lieberthal, A., Carroll, A., Chonmaitree, T., Ganiats, T., Hoberman, A., Jackson, M., … Tunkel, D. (2013). The diagnosis and management of acute otitis media. Pediatrics 131(3), 964-99.

Van de Pol, A. C., van der Gugten, A. C., van der Ent, C. K., Schilder, A. G., Benthem, E. M., Smit, H. A.,… Damoiseaux, R. A. (2013). Referrals for recurrent respiratory tract infections including otitis media in young children. International Journal of Pediatric Otorhinolaryngology, 77(6), 906-910.

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