J Korean Med Assoc.  2015 Jul;58(7):635-644. 10.5124/jkma.2015.58.7.635.

The diagnosis and management of otitis media in children

• Lee HJ
• Kim JH
• Park SK
• Kim HJ

• KMID: 2064920
• DOI: http://doi.org/10.5124/jkma.2015.58.7.635

Abstract

Otitis media is one of the most common bacterial infectious diseases in children and the most common indication for the prescription of antibiotics in Korea. Otitis media, including acute otitis media (AOM) and otitis media with effusion (OME), is also one of the most common reasons for an illness-related visit to a primary care clinician. The first step in management decisions regarding otitis media must focus on accurate diagnosis to distinguish normal from AOM or OME. In 2010, the Korean Otologic Society published the first version of a set of evidence-based clinical practice guidelines for pediatric otitis media. In 2014, revised clinical practice guidelines were published for otitis media that applied to children under 15 years of age. The guidelines addressed the diagnosis and management of otitis media as well as pain management, choice of antibiotics, and methods for prevention. These guidelines recognized that many episodes of otitis media will resolve on their own without antimicrobial therapy; therefore, one of the recommendations for the initial treatment of otitis media in specified situations is watchful waiting without antibacterial therapy. This study introduces excerpts of the guidelines for the diagnosis and management of otitis media in children. We then briefly discuss the current knowledge about AOM and OME and address the new AOM and OME guidelines point by point. It is important to remember that the actual management of patients with otitis media should depend on the physician's clinical judgment, the symptoms of the individual child, other underlying medical conditions, ready access to adequate follow-up care, and other features.

Keyword

Otitis media; Acute disease; Otitis media with effusion; Child; Guideline

MeSH Terms

Acute Disease
Anti-Bacterial Agents
Child*
Communicable Diseases
Diagnosis*
Follow-Up Studies
Humans
Judgment
Korea
Otitis Media with Effusion
Otitis Media*
Pain Management
Prescriptions
Primary Health Care
Watchful Waiting
Anti-Bacterial Agents

Figure

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  Figure 1 Tympanic membrane findings for acute otitis media. (A,B) Hyperemia and severe buldging of the tympanic membrane. (C) Hyperemia and moderate bulding of the tympanic membrane.

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  Figure 2 Tympanic membrane findings for otitis media with effusion (OME). (A) OME with small air bubble. (B) OME with mild retraction of pars flaccida of the tympanic membrane. (C) OME with retraction of the tympanic membrane, touching to the medial wall (promontory) of the middle ear.

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  Figure 3 Tympanic membrane findings for adhesive otitis media: an example of the irreversible change of the tympanic membrane.

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  Figure 4 Tympanic membrane findings for tympanosclerosis: (A) tympanosclerosis and otitis media with effusion and (B) tympanosclerosis and tympanic membrane perforation.

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