Groupings:
(1) otitis responsive to therapy
(2) otitis unresponsive to therapy
(3) recurrent otitis media
(4) otitis with residual effusion
(5) otitis with persistent effusion
Otitis responsive to therapy
: In most cases, clinical symptoms and otoscopic findings of inflammation respond within 48 hours of starting antibiotic therapy. The regimens most commonly given are:
(1) amoxicillin
(2) trimethroprim-sulfamethoxazole
(3) erythromycin-sulfisoxazole
Otitis unresponsive to therapy
: Otitis is termed unresponsive if clinical symptoms and otoscopic findings of membrane inflammation persist after 48 hours of antibiotic therapy. Risk factors for treatment failure include:
(1) age less than 15 months
(2) a history of recurrent otitis in the patient or a sibling
(3) a antibiotic treatment course for otitis within the last month
Recurrent otitis media
: Recurrent otitis is when 3 or more episodes of acute otitis occur within a 6 month period. Antibiotics given for prophylaxis to prevent further infection include:
(1) amoxicillin
(2) sulfisoxazole
Otitis with residual effusion
: A residual effusion is one that remains for a period of 6-16 weeks, after which it is classed as a persistent effusion. The presence of an effusion is associated with conductive hearing impairment (mild-to-moderate, 20 dB or more), which can adversely affect language development in small children. Treatment options include:
(1) observation alone
(2) antibiotics (amoxicillin, trimethoprim-sulfamethoxazole, erythromycin-sulfisoxazole)
(3) antibiotics plus corticosteroids (prednisone or prednisolone)
Otitis with persistent effusion
: Persistence of effusion for at least 4 months (16 weeks) and with hearing impairment of at least 20 dB often is the basis for insertion of ventilating tubes in small children.
