AOM

Question 1

What is AOM defined as?

Answer 1

An infection of the middle ear

AOM causes symptoms such as otalgia and fever, with signs including middle ear effusion and a red, bulging tympanic membrane.

Question 2

What are common symptoms of AOM?

Answer 2

• Otalgia
• Fever

Symptoms may vary, but otalgia is often the best clue to diagnosis.

Question 3

What are the causes of AOM?

Answer 3

• Viral pathogens
• Bacterial pathogens

AOM is often preceded by a viral upper respiratory tract infection.

Question 4

What is the role of eustachian tube dysfunction in AOM?

Answer 4

It allows bacterial pathogens to invade the middle ear

Eustachian tube dysfunction can occur after a viral upper respiratory infection.

Question 5

What are the key features to evaluate in the tympanic membrane for AOM diagnosis?

Answer 5

• Colour
• Position
• Translucency
• Mobility

A red, displaced/bulging, opaque and immobile tympanic membrane indicates AOM.

Question 6

What is the recommended first-line antibiotic for AOM?

Answer 6

Amoxicillin

The ideal dose is controversial, but standard-dose or high-dose amoxicillin is suggested.

Question 7

What are the risk factors for drug-resistant organisms in AOM?

Answer 7

• Recent antibiotic use (<3 months)
• Daycare attendance
• Recent episode of AOM
• Treatment failure
• Early recurrence

These factors increase the likelihood of encountering resistant pathogens.

Question 8

What is the duration of therapy recommended for children <2 years of age with AOM?

Answer 8

10 days

For uncomplicated AOM in children ≥2 years, treatment duration is 5 days.

Question 9

True or false: Breastfeeding is protective against AOM.

Answer 9

TRUE

Breastfeeding is associated with lower rates of AOM in childhood.

Question 10

What are some prevention strategies for AOM?

Answer 10

• Vaccination against AOM pathogens
• Risk factor modification

Public health measures like hand hygiene may also reduce AOM cases.

Question 11

What is the impact of pneumococcal conjugate vaccines on AOM?

Answer 11

Decreased frequency of certain pneumococcal serotypes

Vaccination may contribute to a decreased incidence of AOM.

Question 12

What is the common side effect of amoxicillin/clavulanate?

Answer 12

Diarrhea

This antibiotic is used for treatment failure or recurrence in AOM.

Question 13

What should be considered if symptoms do not improve after 72 hours of treatment?

Answer 13

Treatment failure

Further evaluation may be necessary to adjust therapy.

Question 14

What is the recommended analgesic for ear pain in AOM?

Answer 14

• Acetaminophen
• Ibuprofen

Topical analgesia is not recommended.

Question 15

What is the recommended approach for children over 6 months with mild, uncomplicated AOM?

Answer 15

Watchful waiting

This approach is supported by guidelines and allows for monitoring before initiating antibiotics.

Question 16

What is the significance of otalgia in young children?

Answer 16

It may be the best clue to the diagnosis of AOM

Ear pain can be difficult for infants and toddlers to communicate.

Question 17

What is the impact of tobacco smoke exposure on AOM risk?

Answer 17

Higher risk of AOM in childhood

Tobacco smoke exposure is a modifiable risk factor.

Question 18

What is the duration of treatment with high-dose amoxicillin for children under 2 years of age?

Answer 18

10 days

For children aged 2 years and older, the duration is 5 days.

Question 19

What is the exception for the duration of treatment with ceftriaxone?

Answer 19

3 days

This is a shorter duration compared to other antibiotics.

Question 20

What should be considered for children with acute otitis media (AOM) who are 6 months or older with risk factors?

Answer 20

Deferring antibiotic treatment

This is only if follow-up can be ensured and if antibacterial therapy can be initiated if symptoms worsen.

Question 21

What are the recommended antibiotics for treating AOM?

Answer 21

• HD amoxicillin
• Amoxicillin/clavulanate
• Cefprozil
• Cefuroxime axetil
• Ceftriaxone IM/IV

The duration varies based on age and antibiotic used.

Question 22

True or false: Nasal and oral decongestants are recommended for the management of AOM.

Answer 22

FALSE

They have not shown efficacy in resolving symptoms or preventing complications.

Question 23

What is the dosage for high-dose amoxicillin/clavulanate?

Answer 23

75–90 mg/kg/day PO divided BID–TID

Maximum: 4 g/day amoxicillin.

Question 24

What should be done if a child has a true anaphylactic-type allergy to penicillins?

Answer 24

Consider alternative antibiotics

Options include cefuroxime, clarithromycin, azithromycin, or clindamycin.

Question 25

What is the **maximum dosage** for **ceftriaxone** when administered IM/IV?

Answer 25

1 g ## Footnote Administered at 50 mg/kg Q24H for 3 days.

Question 26

What is the **treatment duration** for **clindamycin**?

Answer 26

30 mg/kg/day (maximum 1.8 g/day) PO/IV divided TID ## Footnote For severe infections, it may increase to 40 mg/kg/day.

Question 27

What is the **recommended action** if middle ear effusion persists for longer than 3 months?

Answer 27

Arrange an audiology assessment ## Footnote This is to evaluate hearing.

Question 28

What is the **recommended vaccine** for children under 5 years with recurrent AOM?

Answer 28

Conjugated pneumococcal vaccine ## Footnote It is advised to give the influenza vaccine yearly for all ages.