Otitis media prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Hardik Patel, M.D.; Faizan Sheraz, M.D. [2]; Luke Rusowicz-Orazem, B.S.
Overview
Preventing otitis media primarily involves preventing developing nasopharyngitis. This is achieved by the pneumococcal and influenza vaccines, frequently washing hands, and avoiding fluid transmission and respiratory droplets from nasopharyngitis patients. Preventing exposure to air pollution as potential middle ear irritants, such as secondhand smoke, contributes to preventing otitis media. For infants, preventative measures include avoiding pacifiers, avoiding daycare enrollment, and breastfeeding until at least 6 months of age. A prophylactic regimen of antibiotics can prevent otitis media in at-risk infants and children. For otitis media that is chronic or recurrent, preventing recurrence of the disease involves surgery, assuming the manifestation is not self-limited. Myringotomy with tympanostomy tube is the most common surgical preventative measure.
Primary Prevention
- Preventative measures for otitis media involve preventing the development of nasopharyngitis from infectious pathogens:
- Administering the following vaccinations:[1]
- Washing hands frequently.
- Avoiding fluid transmission with nasopharyngitis patients.
- Avoiding coughing and respiratory droplets from respiratory illness indicative nasopharyngitis.
- Avoiding first or secondhand smoke or other air pollutants with potential for middle ear irritation.[2]
- Avoiding use of pacifiers in infants.
- Avoiding enrollment in daycares.
- Breastfeeding infants until at least 6 months of age.[3]
- This is correlated with higher levels of antibodies to acute otitis media cause nontypeable Haemophilus influenzae, as well as pathogenic outer membrane protein P6.
- Administering a prophylactic antibiotic regimen for children at risk for developing otitis media:
- Preferred regimen (1): Amoxicillin 20 mg/kg po once daily.[4]
- Preferred regimen (2): Sulfisoxazole 50 mg/kg po at bedtime.[4]
- Alternative Regimen (1): TMP-SMX 4 mg-20 mg/kg once daily.[4]
Secondary Prevention
- For chronic, recurrent cases of otitis media with suppuration or effusion, the most common preventative measure is surgery.[5]
- Myringotomy with tympanostomy tube is used to prevent recurrence of otitis media due to build up of suppurative discharge or effusive fluid buildup.[6]
References
- ↑ Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA, Joffe MD, Miller DT, Rosenfeld RM, Sevilla XD, Schwartz RH, Thomas PA, Tunkel DE (2013). "The diagnosis and management of acute otitis media". Pediatrics. 131 (3): e964–99. doi:10.1542/peds.2012-3488. PMID 23439909.
- ↑ "Ear infection - acute: MedlinePlus Medical Encyclopedia".
- ↑ Sabirov A, Casey JR, Murphy TF, Pichichero ME (2009). "Breast-feeding is associated with a reduced frequency of acute otitis media and high serum antibody levels against NTHi and outer membrane protein vaccine antigen candidate P6". Pediatr. Res. 66 (5): 565–70. doi:10.1203/PDR.0b013e3181b4f8a6. PMC 2783794. PMID 19581824.
- ↑ 4.0 4.1 4.2 Leach AJ, Morris PS (2006). "Antibiotics for the prevention of acute and chronic suppurative otitis media in children". Cochrane Database Syst Rev (4): CD004401. doi:10.1002/14651858.CD004401.pub2. PMID 17054203.
- ↑ Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M (2014). "Update on otitis media - prevention and treatment". Infect Drug Resist. 7: 15–24. doi:10.2147/IDR.S39637. PMC 3894142. PMID 24453496.
- ↑ Bluestone CD (1984). "Surgical management of otitis media". Pediatr Infect Dis. 3 (4): 392–6. PMID 6540871.