Review Question - QID 105560

This child most likely have acute otitis media (AOM), as evidenced by the irritability and poor feeding and confirmed by otoscopic exam. The most common cause of acute otitis media is S. pneumoniae.

AOM is usually seen in children and is often precipitated (though not caused directly) by a viral URI. Predisposing conditions include altered anatomy of the Eustascian tubes (including trisomy 21 and cleft palate), immune deficiencies, secondhand smoke, day care, and a history of previous ear infections. Symptoms include ear tugging, fever, hearing loss, irritability, feeding difficulties, and vomiting.

Ramakrishnan discusses the diagnostic criteria for acute otitis media, which includes rapid onset of symptoms, middle ear effusion, and signs and symptoms of middle ear inflammation. The most common organisms isolated from middle ear fluid in AOM are Streptococcus pneumoniae (40%), Haemophilus influenzae, and Moraxella catarrhalis in children. Antibiotic therapy is recommended in all children less than six months, between six months and two years if the diagnosis is certain, and in children with severe infection. The first line therapy for AOM is high-dose amoxicillin (80 to 90 mg per kg per day).

Lamber and Roy discuss the management of AOM, including the placement of myringotomy tubes. Myringotomy tubes remain an effective treatment of recurrent acute otitis media and chronic otitis media with effusion. Infants and young children are prone to these entities because of the immature anatomy of their Eustacian tube and as well as lesser-developed immune systems.

Image A shows an example of an erythematous and bulging TM classic of acute OM.

Incorrect Answers:
Answer 1: H. influenza causes approximately 25-30% of AOM cases.
Answer 3: M. catarrhalis causes approximately 10-15% of AOM cases.
Answer 4: Rhinovirus is the most common viral cause of AOM but causes a minority of cases.
Answer 5: RSV is a known cause of AOM but in a minority of cases.