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.
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