Acute otitis media (AOM) is a condition that affects children from various demographic categories and is commonly seen in primary care offices (Liese et al., 2014). Approximately 25 percent of children will be presented to a clinic with an episode of AOM by age 12 years (Dickson, 2014). Risk factors for the disease include, but are not limited to, a low socioeconomic status, proximity of siblings, premature birth, formula feeding, and family history of recurrent episodes of AOM (Dickson, 2014). The aim of this paper is to analyze a case study of a sixteen-month-old patient, SJ, with a previous history of AOM.
Analysis
According to acute otitis media (AOM) practice guidelines issued by the American Academy of Pediatrics (AAP), “clinicians should diagnose acute otitis media (AOM) in children who present with moderate to severe bulging of the tympanic membrane (TM)” (as cited in Lieberthal et al., 2013, p. e964). Taking into consideration the fact that the right TM of the patient is bulging, it can be argued that one criterion for the diagnosis is met. The recent onset of tugging of the ear also falls into the category of data supporting the diagnosis. The fact that SJ has erythema of both TMs also serves as evidence for making a diagnosis of AOM.
Limited mobility of the right TM, sleep disorder, and fever also support the diagnosis. However, the presence of erythema if it is not intense is not helpful diagnostically (Lieberthal et al., 2013). The liquid in the middle ear alone cannot be considered a sufficient evidence of the condition (Atkinson, Wallis, & Coatesworth, 2015). It should be noted that according to a key action statement in the AOM practice guidelines, “clinicians should not diagnose AOM in children who do not have middle ear effusion (MEE)” (as cited in Lieberthal et al., 2013, p. e964).
AOM has to be distinguished from otitis media with effusion (OME), which is a possible sequelae of the condition (Dickson, 2014). OME may also result from an infection of an upper respiratory tract, and it is a very common cause of hearing loss in children (Chonmaitree et al., 2014). According to Kountakis (2013), almost 90 percent of children will have OME at some point before school age. Unlike AOM, OME is not an infectious process; therefore, it is possible to distinguish between the two conditions by the lack of otalgia or erythematous TM (Dickson, 2014). Pneumatic otoscopy can be utilized for diagnosing OME (Dickson, 2014).
Taking into consideration the fact that the disease is unilateral, the prescription of antibiotics is not necessary. However, SJ has a persistent fever; therefore, according to AOM practice guidelines, it is recommended to treat the child with antibiotics (Lieberthal et al., 2013). Moreover, the patient has otorrhea, which precludes observation as a sole course of action. In terms of antibiotics, SJ should be prescribed amoxicillin at a dose of 80 to 90 mg/kg/d (Dickson, 2014).
If the child is not responsive to the treatment, a high-dose of amoxicillin/clavulanate may be used. The duration of the therapy is approximately ten days (quote). The mother has to be informed that children with 4 episodes of AOM within a year “should be considered for placement of tympanostomy tubes” (Dickson, 2014, p. 15). She should also be advised against using a pacifier in the future since it can significantly increase the risk of AOM (Barber, Ille, Vergison, & Coates, 2014).
Conclusion
The analysis of the case study showed that the provided information is sufficient for diagnosing the patient with AOM. The course of treatment and prevention instructions were provided to the patient’s mother.
References
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Barber, C., Ille, S., Vergison, A., & Coates, H. (2014). Acute otitis media in young children – what do parents say? International Journal of Pediatric Otorhinolaryngology, 78(2), 300-306.
Chonmaitree, T., Alvarez-Fernandez, P., Jennings, K., Trujillo, R., Marom, T., Loeffelholz, M.,…Pyles, R. (2014). Symptomatic and asymptomatic respiratory viral infections in the first year of life: association with acute otitis media development. Clinical Infectious Diseases, 60(1), 1-9.
Dickson, G. (2014). Acute otitis media. Primary Care: Clinics in Office Practice, 41(1), 11-18.
Kountakis, S. (Ed.). (2013). Encyclopedia of otolaryngology, head and neck surgery (Vol. 1). New York, NY: Springer.
Lieberthal, A., Carroll, A., Chonmaitree, T., Ganiats, T., Hoberman, A., Jackson, M.,…Tunkel, D. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), e964-e999.
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