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Resources in Evidence Repository and Individual Compendia

Bottom Line Recommendations

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.

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.

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 May 2020, Version 2.1

Clinical guidelines

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: 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: 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: Resuscitation of blue baby and the use of prostaglandins

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Linney M, Gnapragassam J, Wilson P, Rodd I

This document relates to the acute management of infants presenting acutely with collapse and/or cyanosis suggestive of congenital heart defect.

Summaries of systematic reviews

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

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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: Topical analgesia for acute otitis media

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Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C

Antibiotics make little difference to children with an uncomplicated ear infection and ear pain. Some advocate ear drops with local anaesthetic such as amethocaine, benzocaine or lidocaine. Five trials (391 participants) were identified; two compared anaesthetic drops to placebo (inactive) drops; and three compared anaesthetic drops to herbal ear drops. There was no strong evidence that herbal ear drops were effective, but anaesthetic drops did provide better pain relief than the inactive drops. Only one trial looked at adverse reactions and reported no cases of ringing in the ears or unsteadiness when walking and three cases of very mild dizziness. Children in all the trials experienced a rapid, short-term reduction in pain after using ear drops. It is hard to know if this was the result of the natural course of the illness; the placebo effect of receiving treatment; the soothing effect of any liquid in the ear or the pharmacological effects of the ear drops themselves. Nevertheless, there is some evidence that when combined with oral pain medication, anaesthetic ear drops may help to relieve pain more rapidly in children aged three to 18 years. More good-quality trials are needed.

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

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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.

Overviews of systematic reviews

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

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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

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

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van Zon A, van der Heijden GJ, van Dongen TM, Burton MJ, Schilder AG

OBJECTIVES: To assess the effects of antibiotics in children up to 18 years with OME.

Cochrane Systematic Review: Antihistamines and/or decongestants for otitis media with effusion (OME) in children

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Griffin G, Flynn CA

OBJECTIVES: The objective of this review was to determine whether antihistamine, decongestant or combination therapy is effective in treating children who present with OME.

Cochrane Systematic Review: Identification of children in the first four years of life for early treatment for otitis media with effusion

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Simpson SA, Thomas CL, van der Linden MK, Macmillan H, van der Wouden JC, Bu...

OBJECTIVES: The aim of this review was to assess evidence from randomised controlled trials about the effect, on language and behavioural outcomes, of screening and treating children with clinically important OME in the first four years of their life. The focus was on the first four years of life because this is the time of most rapid language development. The consequences of hearing loss are likely to be most serious during this time. In addition, children of this age are least likely to be able to report or seek help for impaired hearing, particularly if these problems have a slow onset and are subtle.

Cochrane Systematic Review: Oral or topical nasal steroids for hearing loss associated with otitis media with effusion in children

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Simpson SA, Lewis R, van der Voort J, Butler CC

OBJECTIVES: To examine the evidence for treating children with hearing loss associated with OME with systemic or topical intranasal steroids.

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

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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: Decongestants and antihistamines for acute otitis media in children

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Coleman C, Moore M.

Objectives: To determine the efficacy of decongestant and antihistamine therapy in children with AOM on outcomes of AOM resolution, symptom resolution, medication side effects, and complications of AOM.

Cochrane Systematic Review: Once or twice daily versus three times daily amoxicillin with or without clavulanate for the treatment of acute otitis media

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Thanaviratananich S, Laopaiboon M, Vatanasapt P.

Objectives: To compare the effectiveness of one or two daily doses with three or four daily doses of amoxicillin, with or without clavulanate, for the treatment of AOM in children; and to compare complication rates and adverse reactions.

Cochrane Systematic Review: Short-course antibiotics for acute otitis media

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Kozyrskyj A, Klassen TP, Moffatt M, Harvey K.

Objectives: To determine the effectiveness of a short course of antibiotics (less than seven days) in comparison to a long course of antibiotics (seven days or greater) for the treatment of AOM in children.

Cochrane Systematic Review: Topical analgesia for acute otitis media

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Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C.

Objectives: To assess the effectiveness of topical analgesia for AOM.

Cochrane Systematic Review: Antibiotics for acute otitis media in children

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

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

Cochrane Systematic Review: Antibiotics for the prevention of acute and chronic suppurative otitis media in children

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Leach AJ, Morris PS

OBJECTIVES: To determine the effectiveness of long-term antibiotics (for longer than six weeks) in preventing any AOM, AOM with perforation and C

Cochrane Systematic Review: Topical analgesia for acute otitis media

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Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C

Objectives: To assess the effectiveness of topical analgesia for AOM.

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

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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.

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

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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

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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

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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

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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.

Key studies

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

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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

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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

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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?

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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

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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

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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

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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

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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.

TREKK.ca Info Pages

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Outstanding Mentor Award

Posted: Nov 03, 2016  | Announcement  | Team: News and Events 



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Updated Bottom Line Recommendations: Acute Otitis Media

Posted: Oct 03, 2019  | Announcement  | Team: News and Events 



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New Evidence Repository

Posted: Oct 18, 2016  | Announcement  | Team: News and Events 



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Updated Resource for Ear Infections

Posted: May 14, 2020  | Announcement  | Team: News and Events 



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Media

Posted: Jan 26, 2017  | Announcement  | Team: Communications 



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TREKK Web Design

Posted: Feb 09, 2011  | Project  | Team: Communications  > Communications



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Federal Government Renews Support for TREKK

Posted: May 01, 2016  | Announcement  | Team: News and Events 



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NEW Parent Tools!

Posted: May 30, 2019  | Announcement  | Team: News and Events 



view 10 more matching info pages

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Parent tools - UTI and Bronchiolitis

Posted: Jan 09, 2020  | Announcement  | Team: News and Events 



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Parent tools - CTV Winnipeg

Posted: Jun 18, 2019  | Announcement  | Team: News and Events 



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Top 10 ED tips for families

Posted: Jul 15, 2016  | Announcement  | Team: News and Events 



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CBC Radio Active Child Health Series

Posted: Sep 08, 2016  | Announcement  | Team: News and Events 



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OUTCH Study

Posted: Feb 19, 2016  | Announcement  | Team: News and Events 



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Webinar: Mobilizing knowledge to improve pediatric health care

Posted: Mar 29, 2016  | Announcement  | Team: News and Events 



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Why should Canada invest in emergency care for children:

Posted: Jul 18, 2017  | Announcement  | Team: News and Events 




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