Diagnosis and Treatment of Otitis Media in Children - PDF by gxr14046

VIEWS: 26 PAGES: 1

									Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of otitis media in children. Bloomington (MN): Institute for
Clinical Systems Improvement (ICSI); 2004 May. 27 p.

                           Diagnosis and Treatment of Otitis Media in Children
                    2                                                       1
                    Symptoms Suggestive of                    Caregiver or patient calls with
                    Otitis Media                                   otitis media-related
                                                                 symptoms or concerns
                                                                                           A
                    Children < 3 Years
                    -   irritability
                    -   fever
                    -   night waking                                        2
                    -   poor feeding                                                                             3
                    -   coryza                                         Symptoms
                                                                                            no           Triage for other
                    -   conjunctivitis                                suggestive of
                                                                                                         illnesses and/or
                    -   balance problems                              otitis media?
                                                                                                            reassurance A
                    -   hearing loss
                                                                            AD
                    -   otalgia
                                                                                 yes
                    Children 3 Years and Older
                    -   otalgia                                             4
                    -   otorrhea                                  Schedule appointment
                    -   hearing loss                                 within 24 hours   AD
                    -   ear popping
                    -   ear fullness
                    -   dizziness
                                                                             5                                  15
                    5
                                                                          Meets
                    Diagnostic Criteria for Acute                   diagnostic criteria     no                Meets              no
                    Otitis Media (AOM)                                  for AOM?                        diagnostic criteria
                     • Middle ear effusion (seen on                                                         for OME?
                         exam and/or confirmed by                           AD                                  AD
                         pneumatic otoscopy) with                                yes                                 yes
                         either:
                         - local signs of inflammation;
                            or                                                 6
                                                                    Discuss prevention                  Refer to Otitis Media
                         - otalgia, otorrhea, irritability,                                            with Effusion Algorithm
                            restlessness, or poor                       otitis media   AD                      (box 16)
                            feeding.

                    Diagnostic Criteria for Otitis                            7
                    Media with Effusion (OME)                       Initiate appropriate
                    • Middle ear effusion (seen on                        treatment      AD
                        exam and/or confirmed by
                        pneumatic otoscopy) or
                        abnormal tympanometry
                        without signs or symptoms of                         8
                        AOM.
                                                                         History of
                    7                                                recurrent AOM?                               9
                                                                  (3 episodes/6 months,          yes          Consider
                    Appropriate Treatment
                                                                  4 episodes/12 months)                  prophylactic regimen
                    • Antibiotic regimen using                                                                              AD
                       criteria for first vs. second line
                       antibiotics                                          AD
                                      or
                    • Observation for mildly                                         no
                       symptomatic children
                                                                             10
                                                                     Schedule follow-up
                                                                       in 3-4 weeks
                                                                                           AD



                                                                             11                                      12
                        A = Annotation
                        D = Discussion                                                                           Criteria
                                                                                                no                                no
                                                                       AOM resolved?                        for ENT referral
                                                                                                                  met?
                                                                                 A
                                                                                                                     AD
                                                                                     yes                                  yes

                                                                              14                                   13
                                                                       Out of guideline                      Consider ENT
                                                                                                                referral


                             All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.

								
To top