title: Primary care management of otitis media among Australian children.
abstract: Acute otitis media (AOM) is diagnosed on the basis of acute onset of pain and fever; a red, bulging tympanic membrane; and middle ear effusion. AOM is managed with analgesia (paracetamol or non-steroidal anti-inflammatory drugs). Antibiotic therapy is minimally effective for most patients; it is most effective for children < 2 years with bilateral otitis media and for children with discharging ears. National guidelines recommend antibiotic therapy for Indigenous children with AOM. Evidence for corticosteroids, topical analgesia and xylitol are scant. Otitis media with effusion (OME) is diagnosed as the presence of middle ear effusion (type B tympanogram or immobile tympanic membrane on pneumatic otoscopy) without AOM criteria. Well children with OME with no speech and language delays can be observed for the first 3 months; perform audiological evaluation and refer to an ear, nose and throat (ENT) specialist if they have bilateral hearing impairment > 30 dB or persistent effusion. Children with effusions persisting longer than 3 months can benefit from a 2-4-week course of amoxycillin. Chronic suppurative otitis media is a chronic discharge through a tympanic membrane perforation. It is managed with regular ear cleaning (dry mopping or povidone-iodine [Betadine] washouts) until discharge resolves; topical ear drops (eg, ciprofloxacin); audiological evaluation; and ENT review.
authors.affiliation: General Medicine, Children's Hospital at Westmead, Sydney, NSW, Australia. hasanthg@chw.edu.au
authors.forename: Hasantha
authors.initials: H
authors.lastname: Gunasekera
authors.forename: Tony E
authors.initials: TE
authors.lastname: O'Connor
authors.forename: Shyan
authors.initials: S
authors.lastname: Vijayasekaran
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Del Mar
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001315:Australia; D002675:Child, Preschool; D034381:Hearing Loss / Q000517:prevention & control; D006801:Humans; D007223:Infant; D008876:Middle Ear Ventilation; D010034:Otitis Media with Effusion / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D010035:Otitis Media, Suppurative / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D011320:Primary Health Care; D012017:Referral and Consultation
chemical_list: D000900:Anti-Bacterial Agents