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Acute otitis media (AOM) is a common, symptomatic infection of the middle ear. Nasopharyngeal secretions that contain viruses and bacteria can enter the middle ear via the eustachian tube. Usually the middle ear drains well but if there is eustachian tube swelling, fluid from the middle ear may not drain properly. Under these conditions bacteria and viruses present in the middle ear can multiply, creating clinical AOM.

BROWSE EVIDENCE REPOSITORY

 

Bottom Line Recommendations English (5) French (1) All (6)

Bottom Line Recommendations: Acute Otitis Media

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Le Saux N, TREKK Network

Bottom Line Recommendations for diagnosis and treatment of AOM. Posted online September 2019, Version 2.0

Acute Otitis Media- Emergency Management in Children - Flowchart

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Children's Health Queensland Hospital and Health Service

Flowchart of emergency management in children for acute otitis media.

Otitis Media

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Bugs & Drugs

Acute Otitis Media prevention and antibiotic therapy.

Flow diagram for the management of children with suspected and confirmed acute otitis media

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Le Saux N, Robinson JL, Canadian Paediatric Society, Infectious Diseases and ...

Flow chart of criteria for management of children with suspected and confirmed acute otitis media based on symptoms of children over 6 months of age.

Videos in clinical medicine. Diagnosing otitis media--otoscopy and cerumen removal

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Shaikh N, Hoberman A, Kaleida PH, Ploof DL, Paradise JL

Video instructing how to diagnose otitis media with otoscopy and cerum removal.

Recommandations de Base: Otite moyenne aigu

Download

Le Saux N, TREKK Network

Bottom Line Recommendations for diagnosis and treatment of AOM-French. Posted September 2019, Version 2.0

Bottom Line Recommendations: Acute Otitis Media

Download

Le Saux N, TREKK Network

Bottom Line Recommendations for diagnosis and treatment of AOM. Posted online September 2019, Version 2.0

Recommandations de Base: Otite moyenne aigu

Download

Le Saux N, TREKK Network

Bottom Line Recommendations for diagnosis and treatment of AOM-French. Posted September 2019, Version 2.0

Acute Otitis Media- Emergency Management in Children - Flowchart

Visit

Children's Health Queensland Hospital and Health Service

Flowchart of emergency management in children for acute otitis media.

Otitis Media

Visit

Bugs & Drugs

Acute Otitis Media prevention and antibiotic therapy.

Flow diagram for the management of children with suspected and confirmed acute otitis media

Visit

Le Saux N, Robinson JL, Canadian Paediatric Society, Infectious Diseases and ...

Flow chart of criteria for management of children with suspected and confirmed acute otitis media based on symptoms of children over 6 months of age.

Videos in clinical medicine. Diagnosing otitis media--otoscopy and cerumen removal

Visit

Shaikh N, Hoberman A, Kaleida PH, Ploof DL, Paradise JL

Video instructing how to diagnose otitis media with otoscopy and cerum removal.

Clinical guidelines English (4) French All (4)

Clinical Practice Guideline: Acute otitis media - Emergency management in children

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Children's Health Queensland Hospital and Health Service

Children's Health Queensland Statewide Paediatric Guideline for emergency management of acute otitis media in children.

Clinical Practice Guideline: Management of acute otitis media in children six months of age and older

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Le Saux N, Robinson JL, Canadian Paediatric Society, Infectious Diseases and ...

Canadian Paediatric Society position statement on the management of acute otitis media in children aged 6 months and older.

Clinical Practice Guideline: Danish guidelines on management of otitis media in preschool children

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Heidemann CH, Lous J, Berg J, Christensen JJ, Hkonsen SJ, Jakobsen M, Johanse...

The Danish Health and Medicines Authority and the Danish Society of Otorhinolaryngology guidelines regarding the diagnostic criteria for acute otitis media and surgical treatment of recurrent AOM and chronic OME in preschool children.

Clinical Practice Guideline: The diagnosis and management of acute otitis media

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Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA,...

Evidence-based clinical practice guideline from the American Academy of Pediatrics (AAP) and American Academy of Family Physicians.

Clinical Practice Guideline: Acute otitis media - Emergency management in children

Visit

Children's Health Queensland Hospital and Health Service

Children's Health Queensland Statewide Paediatric Guideline for emergency management of acute otitis media in children.

Clinical Practice Guideline: Management of acute otitis media in children six months of age and older

Visit

Le Saux N, Robinson JL, Canadian Paediatric Society, Infectious Diseases and ...

Canadian Paediatric Society position statement on the management of acute otitis media in children aged 6 months and older.

Clinical Practice Guideline: Danish guidelines on management of otitis media in preschool children

Visit

Heidemann CH, Lous J, Berg J, Christensen JJ, Hkonsen SJ, Jakobsen M, Johanse...

The Danish Health and Medicines Authority and the Danish Society of Otorhinolaryngology guidelines regarding the diagnostic criteria for acute otitis media and surgical treatment of recurrent AOM and chronic OME in preschool children.

Clinical Practice Guideline: The diagnosis and management of acute otitis media

Visit

Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA,...

Evidence-based clinical practice guideline from the American Academy of Pediatrics (AAP) and American Academy of Family Physicians.

Summaries of systematic reviews English (4) French All (4)

Cochrane Summary: Systemic corticosteroids for improving symptoms in children with acute middle ear infection

Visit

Ranakusuma RW, Pitoyo Y, Safitri ED, Thorning S, Beller EM, Sastroasmoro S, D...

Objective: To assess the effects of systemic corticosteroids (oral or parenteral), with or without antibiotics, for AOM in children.

Cochrane Summary: Influenza vaccine for preventing acute otitis media (middle ear infection)

Visit

Norhayati MN, Ho JJ, Azman MY

Objective: To assess the effectiveness of influenza vaccine in reducing the occurrence of acute otitis media in infants and children.

Cochrane Summary: Pain relievers for children with acute middle ear infection

Visit

Sjoukes A, Venekamp RP, van de Pol AC, Hay AD, Little P, Schilder AG, Damoise...

Objective: Our primary objective was to assess the effectiveness of paracetamol (acetaminophen) or NSAIDs, alone or combined, compared with placebo or no treatment in relieving pain in children with AOM. Our secondary objective was to assess the effectiveness of NSAIDs compared with paracetamol in children with AOM.

Cochrane Summary: Antibiotics for otitis media with effusion ('glue ear') in children

Visit

Venekamp RP, Burton MJ, van Dongen TM, van der Heijden GJ, van Zon A, Schilde...

Objective: To assess the benefits and harms of oral antibiotics in children up to 18 years with OME.

Cochrane Summary: Systemic corticosteroids for improving symptoms in children with acute middle ear infection

Visit

Ranakusuma RW, Pitoyo Y, Safitri ED, Thorning S, Beller EM, Sastroasmoro S, D...

Objective: To assess the effects of systemic corticosteroids (oral or parenteral), with or without antibiotics, for AOM in children.

Cochrane Summary: Influenza vaccine for preventing acute otitis media (middle ear infection)

Visit

Norhayati MN, Ho JJ, Azman MY

Objective: To assess the effectiveness of influenza vaccine in reducing the occurrence of acute otitis media in infants and children.

Cochrane Summary: Pain relievers for children with acute middle ear infection

Visit

Sjoukes A, Venekamp RP, van de Pol AC, Hay AD, Little P, Schilder AG, Damoise...

Objective: Our primary objective was to assess the effectiveness of paracetamol (acetaminophen) or NSAIDs, alone or combined, compared with placebo or no treatment in relieving pain in children with AOM. Our secondary objective was to assess the effectiveness of NSAIDs compared with paracetamol in children with AOM.

Cochrane Summary: Antibiotics for otitis media with effusion ('glue ear') in children

Visit

Venekamp RP, Burton MJ, van Dongen TM, van der Heijden GJ, van Zon A, Schilde...

Objective: To assess the benefits and harms of oral antibiotics in children up to 18 years with OME.

Overviews of systematic reviews English (1) French All (1)

Evidence Summary: Are topical antibiotics an alternative to oral antibiotics for children with acute otitis media and ear discharge?

Visit

Venekamp RP, Prasad V, Hay AD

Objective: To review the evidence comparing efectiveness of topical antibiotics with oral antibiotics, placebo, or no treatment in children with AOM presenting with ear discharge caused by spontaneous perforation of the eardrum.

Evidence Summary: Are topical antibiotics an alternative to oral antibiotics for children with acute otitis media and ear discharge?

Visit

Venekamp RP, Prasad V, Hay AD

Objective: To review the evidence comparing efectiveness of topical antibiotics with oral antibiotics, placebo, or no treatment in children with AOM presenting with ear discharge caused by spontaneous perforation of the eardrum.

Systematic reviews English (9) French All (9)

Systematic Review: A systematic review and meta-analysis of antimicrobial resistance in paediatric acute otitis media

Visit

Michael W. Mathera, Michael Drinnana, John D. Perryc, Steven Powellb, Janet A...

Objective: We present a comprehensive review and meta-analysis, of both the microbiology and antimicrobial resistance of AOM organisms to commonly used antimicrobial agents, with the aim of informing responsible antimicrobial stewardship.

Review: From paper to practice: Strategies for improving antibiotic stewardship in the pediatric ambulatory setting.

Visit

Bozzella MJ, Harik N, Newland JG, Hamdy RF

Objective: The intent with this review is to provide an overview of strategies that pediatric providers can take from paper to practice.

Cochrane Systematic Review: Systemic corticosteroids for acute otitis media in children

Visit

Ranakusuma RW, Pitoyo Y, Safitri ED, Thorning S, Beller EM, Sastroasmoro S, D...

Objective: To assess the effects of systemic corticosteroids (oral or parenteral), with or without antibiotics, for AOM in children.

Cochrane Systematic Review: Influenza vaccines for preventing acute otitis media in infants and children

Visit

Norhayati MN, Ho JJ, Azman MY

Objective: To assess the effectiveness of influenza vaccine in reducing the occurrence of acute otitis media in infants and children.

Review: Antibiotic therapy for children with acute otitis media

Visit

Sakulchit T, Goldman RD

Objective: Review of AOM and the evidence regarding use of antibiotics or watchful waiting to treat children at different levels of disease severity.

Cochrane Systematic Review: Paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs, alone or combined, for pain relief in acute otitis media in children

Visit

Sjoukes A, Venekamp RP, van de Pol AC, Hay AD, Little P, Schilder AG, Damoise...

Objective: Our primary objective was to assess the effectiveness of paracetamol (acetaminophen) or NSAIDs, alone or combined, compared with placebo or no treatment in relieving pain in children with AOM. Our secondary objective was to assess the effectiveness of NSAIDs compared with paracetamol in children with AOM.

Cochrane Systematic Review: Antibiotics for otitis media with effusion in children

Visit

Venekamp RP, Burton MJ, van Dongen TM, van der Heijden GJ, van Zon A, Schilde...

Objective: To assess the benefits and harms of oral antibiotics in children up to 18 years with OME.

Cochrane Systematic Review: Antibiotics for acute otitis media in children

Visit

Venekamp RP, Sanders SL, Glasziou PP, Del Mar CB, Rovers MM

Objective: To assess the effects of antibiotics for children with AOM.

Systematic Review: Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis

Visit

Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD

Objective: To systematically review the literature and, where appropriate, meta-analyse studies investigating subsequent antibiotic resistance in individuals prescribed antibiotics in primary care.

Systematic Review: A systematic review and meta-analysis of antimicrobial resistance in paediatric acute otitis media

Visit

Michael W. Mathera, Michael Drinnana, John D. Perryc, Steven Powellb, Janet A...

Objective: We present a comprehensive review and meta-analysis, of both the microbiology and antimicrobial resistance of AOM organisms to commonly used antimicrobial agents, with the aim of informing responsible antimicrobial stewardship.

Review: From paper to practice: Strategies for improving antibiotic stewardship in the pediatric ambulatory setting.

Visit

Bozzella MJ, Harik N, Newland JG, Hamdy RF

Objective: The intent with this review is to provide an overview of strategies that pediatric providers can take from paper to practice.

Cochrane Systematic Review: Systemic corticosteroids for acute otitis media in children

Visit

Ranakusuma RW, Pitoyo Y, Safitri ED, Thorning S, Beller EM, Sastroasmoro S, D...

Objective: To assess the effects of systemic corticosteroids (oral or parenteral), with or without antibiotics, for AOM in children.

Cochrane Systematic Review: Influenza vaccines for preventing acute otitis media in infants and children

Visit

Norhayati MN, Ho JJ, Azman MY

Objective: To assess the effectiveness of influenza vaccine in reducing the occurrence of acute otitis media in infants and children.

Review: Antibiotic therapy for children with acute otitis media

Visit

Sakulchit T, Goldman RD

Objective: Review of AOM and the evidence regarding use of antibiotics or watchful waiting to treat children at different levels of disease severity.

Cochrane Systematic Review: Paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs, alone or combined, for pain relief in acute otitis media in children

Visit

Sjoukes A, Venekamp RP, van de Pol AC, Hay AD, Little P, Schilder AG, Damoise...

Objective: Our primary objective was to assess the effectiveness of paracetamol (acetaminophen) or NSAIDs, alone or combined, compared with placebo or no treatment in relieving pain in children with AOM. Our secondary objective was to assess the effectiveness of NSAIDs compared with paracetamol in children with AOM.

Cochrane Systematic Review: Antibiotics for otitis media with effusion in children

Visit

Venekamp RP, Burton MJ, van Dongen TM, van der Heijden GJ, van Zon A, Schilde...

Objective: To assess the benefits and harms of oral antibiotics in children up to 18 years with OME.

Cochrane Systematic Review: Antibiotics for acute otitis media in children

Visit

Venekamp RP, Sanders SL, Glasziou PP, Del Mar CB, Rovers MM

Objective: To assess the effects of antibiotics for children with AOM.

Systematic Review: Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis

Visit

Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD

Objective: To systematically review the literature and, where appropriate, meta-analyse studies investigating subsequent antibiotic resistance in individuals prescribed antibiotics in primary care.

Key studies English (8) French All (8)

Key study: Acute otitis media in children presenting to the emergency department: Is it diagnosed and managed appropriately?

Visit

Niroshan Balasundaram, Dung Phan, Daniel Mazzoni, Elliot Duong, Amy Sweeny, C...

Objective: To describe the diagnostic and management practice in children with acute otitis media (AOM) presenting to the emergency department (ED) and compare diagnosis and management against existing guidelines.

Key study: Diagnostic Accuracy, Prescription Behavior, and Watchful Waiting Efficacy for Pediatric Acute Otitis Media

Visit

Brinker DL Jr, MacGeorge EL, Hackman N

Objective: To assess the implications and recommendations to improve antibiotic stewardship through watchful waiting as an alternative to immediate antibiotic treatment in children with AOM.

Key study: Optimising pain management in children with acute otitis media through a primary care-based multifaceted educational intervention: study protocol for a cluster randomised controlled trial

Visit

van Uum RT, Venekamp RP, Sjoukes A, van de Pol AC, de Wit GA, Schilder AGM, D...

Objective: We have developed a primary care-based multifaceted educational intervention to optimise pain management in children with AOM, and we trial its clinical and cost effectiveness.

Key study: Shortened Antimicrobial Treatment for Acute Otitis Media in Young Children

Visit

Hoberman A, Paradise JL, Rockette HE, Kearney DH, Bhatnagar S, Shope TR, Mart...

Objective: Given methodologic limitations in available publications, we undertook the current trial involving children 6 to 23 months of age to determine whether limiting antimicrobial treatment to 5 days rather than using the standard 10-day regimen would afford equivalent outcomes and whether doing so also for subsequent episodes would lead to a reduction in the overall use of antimicrobial treatment, with a resulting reduction in the development of antimicrobial resistance.

Key study: Use of symptoms and risk factors to predict acute otitis media in infants

Visit

McCormick DP, Jennings K, Ede LC, Alvarez-Fernandez P, Patel J, Chonmaitree T

Objective: The purpose of this study was to evaluate the usefulness of symptoms and other risk factors in predicting the presence of AOM in infants.

Key study: Symptomatic and asymptomatic respiratory viral infections in the first year of life: association with acute otitis media development

Visit

Chonmaitree T, Alvarez-Fernandez P, Jennings K, Trujillo R, Marom T, Loeffelh...

Objective: This study determined the epidemiologic characteristics and etiology of asymptomatic upper respiratory tract infection in the first year of life and the association with acute otitis media complication.

Key study: Treatment of acute otitis media in children under 2 years of age

Visit

Hoberman A, Paradise JL, Rockette HE, Shaikh N, Wald ER, Kearney DH, Colborn ...

Objective: We undertook this clinical trial to determine the extent to which antimicrobial treatment affects the course of both symptoms and signs of acute otitis media, irrespective of the apparent severity of the disease, among children 6 to 23 months of age in whom the diagnosis of acute otitis media is quite certain.

Key study: A placebo-controlled trial of antimicrobial treatment for acute otitis media

Visit

Thtinen PA, Laine MK, Huovinen P, Jalava J, Ruuskanen O, Ruohola A

Objective: We conducted a randomized, double-blind, placebo-controlled study of the efficacy of antimicrobial therapy in the age group with the highest incidence of acute otitis media. Our aim was to assess the efficacy of antimicrobial treatment for acute otitis media when strict diagnostic criteria are used and the antimicrobial coverage and dosage of the active treatment are adequate.

Key study: Acute otitis media in children presenting to the emergency department: Is it diagnosed and managed appropriately?

Visit

Niroshan Balasundaram, Dung Phan, Daniel Mazzoni, Elliot Duong, Amy Sweeny, C...

Objective: To describe the diagnostic and management practice in children with acute otitis media (AOM) presenting to the emergency department (ED) and compare diagnosis and management against existing guidelines.

Key study: Diagnostic Accuracy, Prescription Behavior, and Watchful Waiting Efficacy for Pediatric Acute Otitis Media

Visit

Brinker DL Jr, MacGeorge EL, Hackman N

Objective: To assess the implications and recommendations to improve antibiotic stewardship through watchful waiting as an alternative to immediate antibiotic treatment in children with AOM.

Key study: Optimising pain management in children with acute otitis media through a primary care-based multifaceted educational intervention: study protocol for a cluster randomised controlled trial

Visit

van Uum RT, Venekamp RP, Sjoukes A, van de Pol AC, de Wit GA, Schilder AGM, D...

Objective: We have developed a primary care-based multifaceted educational intervention to optimise pain management in children with AOM, and we trial its clinical and cost effectiveness.

Key study: Shortened Antimicrobial Treatment for Acute Otitis Media in Young Children

Visit

Hoberman A, Paradise JL, Rockette HE, Kearney DH, Bhatnagar S, Shope TR, Mart...

Objective: Given methodologic limitations in available publications, we undertook the current trial involving children 6 to 23 months of age to determine whether limiting antimicrobial treatment to 5 days rather than using the standard 10-day regimen would afford equivalent outcomes and whether doing so also for subsequent episodes would lead to a reduction in the overall use of antimicrobial treatment, with a resulting reduction in the development of antimicrobial resistance.

Key study: Use of symptoms and risk factors to predict acute otitis media in infants

Visit

McCormick DP, Jennings K, Ede LC, Alvarez-Fernandez P, Patel J, Chonmaitree T

Objective: The purpose of this study was to evaluate the usefulness of symptoms and other risk factors in predicting the presence of AOM in infants.

Key study: Symptomatic and asymptomatic respiratory viral infections in the first year of life: association with acute otitis media development

Visit

Chonmaitree T, Alvarez-Fernandez P, Jennings K, Trujillo R, Marom T, Loeffelh...

Objective: This study determined the epidemiologic characteristics and etiology of asymptomatic upper respiratory tract infection in the first year of life and the association with acute otitis media complication.

Key study: Treatment of acute otitis media in children under 2 years of age

Visit

Hoberman A, Paradise JL, Rockette HE, Shaikh N, Wald ER, Kearney DH, Colborn ...

Objective: We undertook this clinical trial to determine the extent to which antimicrobial treatment affects the course of both symptoms and signs of acute otitis media, irrespective of the apparent severity of the disease, among children 6 to 23 months of age in whom the diagnosis of acute otitis media is quite certain.

Key study: A placebo-controlled trial of antimicrobial treatment for acute otitis media

Visit

Thtinen PA, Laine MK, Huovinen P, Jalava J, Ruuskanen O, Ruohola A

Objective: We conducted a randomized, double-blind, placebo-controlled study of the efficacy of antimicrobial therapy in the age group with the highest incidence of acute otitis media. Our aim was to assess the efficacy of antimicrobial treatment for acute otitis media when strict diagnostic criteria are used and the antimicrobial coverage and dosage of the active treatment are adequate.