Otitis%20media%20-%20acute Management

• Clinicians should determine appropriate follow-up
• Follow-up exam of asymptomatic patients at the completion of treatment is not necessary
• It is recommended that follow-up exam is done in 3-4 weeks or w/in the next 4-6 weeks
• Middle ear effusion (MEE) can persist for up to 1 month in 50% of patients & up to 3 months in 10% of patients even if there is bacteriologic cure
  
  • Persistence of MEE is not an indication for continued treatment or for another course of antibiotics
• Hearing test should be performed if effusion is present 3 months post acute otitis media (AOM)
  
  • Refer to otolaryngologist if hearing loss persists

Consider expert referral if any of the following occurs:

• If no response to 2nd-line agents
  
  • Tympanocentesis w/ Gram stain & culture is recommended
• Otitis media w/ effusion (OME) for ≥3 months w/ bilateral hearing loss ≥20 dB
• ≥3 episodes in 6 months, ≥4 episodes in 12 months
• Retracted tympanic membrane