Otitis media and the new guidelines

Abstract

Otitis media, including recurrent acute otitis media (AOM) and otitis media with effusion (OME), is one of the most common reasons for an illness-related visit to the primary care clinician. Until recently, antibacterial therapy was the standard treatment for most episodes of AOM and often for OME. However, in 1994, a clinical practice guideline on OME was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality) and applied to normal children aged 1 to 3 years. The recommendations in the 1994 guideline were evidence based, widely discussed, and somewhat controversial but also acted as a starting point for some ideas about standardization of management of this very common disease. In 2004, revised clinical practice guidelines were published for OME that applied to children aged 2 months to 12 years and included children with developmental disabilities and underlying conditions that predispose them to OME. In addition, a new evidence-based clinical practice guideline for AOM was published in 2004. This guideline recognized that many episodes of AOM will resolve on their own without antimicrobial therapy, and on that basis, one of the recommendations for initial treatment of AOM in specified situations was watchful waiting without antibacterial therapy. This article briefly discusses the current knowledge about AOM and OME and then addresses the new AOM and OME guidelines point by point. It is important to remember that although important, these clinical practice guidelines are just guidelines and that actual management of the patient with otitis media depends on clinical judgement, the severity of the illness, other underlying medical conditions, ready access to adequate follow-up care, and other features, such as cultural differences. Surgical recommendations were not included in the AOM guidelines but were addressed in the OME guidelines. Further information about the efficacy and effectiveness of both sets of guidelines will likely include the results of prospective studies using the guidelines in both normal children and those with underlying medical conditions.