Assessment
👂 Acute Otitis Media (AOM) in Adults is rare but can lead to serious complications. Diagnosis is clinical, and treatment focuses on appropriate antibiotics. Referral to an ENT is essential for recurrent or severe cases. Here's a quick guide to diagnosis and treatment.
Dx (Diagnosis) - AOM (Acute Otitis Media)
- 🧑⚕️ Clinical Dx: Based on sx (symptoms), duration, and exam findings.
- 📉 Accuracy of clinical exam can vary.
- 🩺 Classic Triad: Otalgia, TM (Tympanic Membrane) findings, fever = likely AOM.
- 🖼️ Imaging: Rarely needed for uncomplicated AOM. Use CT/MRI for chronic or suppurative cases.
Management
💊 Tx (Treatment)
- 1st-line for healthy adults
- Amox/Clav 500mg TID or 875mg BID (7-10 days).
- Higher doses (1000/62.5mg or 2000/125mg BID) for recent ABX exposure or severe infection.
- Amoxicillin 500mg TID or 875mg BID. Use 1000mg TID for severe cases or immunocompromise.
- Alternatives: Cefuroxime 500mg BID x 7-10 days.
- Beta-lactam allergy or severe infection
- Cefdinir 300mg BID or Cefpodoxime 200mg BID.
- Ceftriaxone 1g IM every other day x 3 doses.
- Severe: Doxycycline 100mg BID, Levofloxacin 500mg daily, Moxifloxacin 400mg daily (7-10 days).
- Immunocompromised or recurrent/chronic infection 👩⚕️
- Amox/Clav 875mg BID or 500mg TID x 10-14 days.
- Cefpodoxime 200mg BID.
- Alternatives: Cefdinir 300mg BID or Levofloxacin 500mg daily (7-10 days).
- Chronic OM (Otitis Media)
- Avoid ear submersion in water.
- ENT referral for aural toilet, possible surgery, and ABX based on cultures.
- Otic ABX used with wet ears 🦻 + chronic TM perforation.
- Address risk factors: smoking, allergies, GERD, sinusitis.
🌬️ Adjunctive Therapy
- Decongestants: Pseudoephedrine 120mg + oxymetazoline nasal spray (2 puffs TID x 3-4 days).
- Antihistamines for RT allergy: Loratadine 10mg daily, Fexofenadine 60mg BID.
- Analgesia: NSAIDs; Ibuprofen 400mg TID x 5d or Celecoxib 200mg daily. Acetaminophen as an alternative.
🔄 Referral for complications
- ENT referral for persistent infection, myringotomy, or tympanostomy tube placement.
- Indications: severe vertigo, facial palsy, mastoid abscess, or meningitis.
References
- Limb C, Lustig L, Durand, M. Acute otitis media in adults. UpToDate. https://www.uptodate.com/contents/acute-otitis-media-in-adults
- Rijk MH, Hullegie S, Schilder AGM, et al. Incidence and management of acute otitis media in adults: a primary care-based cohort study. Fam Pract. 2021;38(4):448-453.
- Pontefract B, Nevers M, Fleming-Dutra KE, et al. Diagnosis and Antibiotic Management of Otitis Media and Otitis Externa in United States Veterans. Open Forum Infect Dis. 2019;6(11):ofz432.
