Ear pain resident survival guide (pediatrics): Difference between revisions

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| [[Ear pain resident survival guide (pediatrics)|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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{{CMG}} {{AE}} [[user:Amira Albawri|Amira Albawri]]
{{CMG}} {{AE}} [[user:Amira Albawri|Amira Albawri]]


{{SK}}
{{SK}} [[Ear pain]] , [[otalgia]] , ear sore , otitis , ear infection , ear discomfort  and ear aches.
 
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==Overview==
==Overview==
Ear pain is the most common cause that affects in children. The mortality rates are generally low but the acute otitis media and otitis media with effusion have high morbidity. the child can come with fever, restless sleep, ear rubbing, irritability, excessive crying, decreased activity, poor appetite, rhinitis, nasal congestion, cough, hoarse voice, conjunctivitis, mucus vomiting.There are several causes divided into primary otalgia and secondary otologia .The primary otalogia including otitis externa (swimmer's ear), mechanical obstruction ,Otitis media ,otitis media with effusion, truma .The secondary otalgia including refered ear pain.
Ear pain is the most common cause that affects children. Mortality rates are generally low, but acute otitis media and otitis media with effusion have high morbidity. the child can come with fever, restless sleep, ear rubbing, irritability, excessive crying, decreased activity, poor appetite, rhinitis, nasal congestion, cough, hoarse voice, conjunctivitis, mucus vomiting.There are several causes divided into primary otalgia and secondary otologia .The primary otalogia including otitis externa (swimmer's ear), mechanical obstruction ,Otitis media ,otitis media with effusion, truma .The secondary otalgia including referred ear pain.


==Causes==
==Causes==
===Life Threatening Causes===
 
Ear pain is not life threatening<ref name="pmid29365233">{{cite journal| author=Earwood JS, Rogers TS, Rathjen NA| title=Ear Pain: Diagnosing Common and Uncommon Causes. | journal=Am Fam Physician | year= 2018 | volume= 97 | issue= 1 | pages= 20-27 | pmid=29365233 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29365233  }}</ref>


===Common Causes===
===Common Causes===


===primary otalgia <ref name="pmid20736106">{{cite journal| author=Neilan RE, Roland PS| title=Otalgia. | journal=Med Clin North Am | year= 2010 | volume= 94 | issue= 5 | pages= 961-71 | pmid=20736106 | doi=10.1016/j.mcna.2010.05.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20736106  }}</ref>===
====Primary otalgia====
 
The following are the causes of primary otalgia:<ref name="pmid20736106">{{cite journal| author=Neilan RE, Roland PS| title=Otalgia. | journal=Med Clin North Am | year= 2010 | volume= 94 | issue= 5 | pages= 961-71 | pmid=20736106 | doi=10.1016/j.mcna.2010.05.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20736106  }}</ref><ref name="pmid29365233">{{cite journal| author=Earwood JS, Rogers TS, Rathjen NA| title=Ear Pain: Diagnosing Common and Uncommon Causes. | journal=Am Fam Physician | year= 2018 | volume= 97 | issue= 1 | pages= 20-27 | pmid=29365233 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29365233  }}</ref>


======[[Otitis externa  (swimmer's ear)]]======
====Otitis externa  (swimmer's ear)====


*[[Pseudomonas]].<ref name="pmid10809975">{{cite journal| author=Zichichi L, Asta G, Noto G| title=Pseudomonas aeruginosa folliculitis after shower/bath exposure. | journal=Int J Dermatol | year= 2000 | volume= 39 | issue= 4 | pages= 270-3 | pmid=10809975 | doi=10.1046/j.1365-4362.2000.00931.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10809975  }}</ref>
*[[Pseudomonas]].<ref name="pmid10809975">{{cite journal| author=Zichichi L, Asta G, Noto G| title=Pseudomonas aeruginosa folliculitis after shower/bath exposure. | journal=Int J Dermatol | year= 2000 | volume= 39 | issue= 4 | pages= 270-3 | pmid=10809975 | doi=10.1046/j.1365-4362.2000.00931.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10809975  }}</ref>
*[[Staph aureus]].<ref name="pmid16138712">{{cite journal| author=Wang MC, Liu CY, Shiao AS, Wang T| title=Ear problems in swimmers. | journal=J Chin Med Assoc | year= 2005 | volume= 68 | issue= 8 | pages= 347-52 | pmid=16138712 | doi=10.1016/S1726-4901(09)70174-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16138712  }}</ref><ref name="pmid231986732">{{cite journal| author=Schaefer P, Baugh RF| title=Acute otitis externa: an update. | journal=Am Fam Physician | year= 2012 | volume= 86 | issue= 11 | pages= 1055-61 | pmid=23198673 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23198673  }}</ref>
*[[Staph aureus]].<ref name="pmid16138712">{{cite journal| author=Wang MC, Liu CY, Shiao AS, Wang T| title=Ear problems in swimmers. | journal=J Chin Med Assoc | year= 2005 | volume= 68 | issue= 8 | pages= 347-52 | pmid=16138712 | doi=10.1016/S1726-4901(09)70174-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16138712  }}</ref><ref name="pmid231986732">{{cite journal| author=Schaefer P, Baugh RF| title=Acute otitis externa: an update. | journal=Am Fam Physician | year= 2012 | volume= 86 | issue= 11 | pages= 1055-61 | pmid=23198673 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23198673  }}</ref>


====[[Mechanical obstruction]]====
====Mechanical obstruction====


*[[Earwax]]<ref name="pmid28045632">{{cite journal| author=Schwartz SR, Magit AE, Rosenfeld RM, Ballachanda BB, Hackell JM, Krouse HJ | display-authors=etal| title=Clinical Practice Guideline (Update): Earwax (Cerumen Impaction) Executive Summary | journal=Otolaryngol Head Neck Surg | year= 2017 | volume= 156 | issue= 1 | pages= 14-29 | pmid=28045632 | doi=10.1177/0194599816678832 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28045632  }} </ref>
*[[Earwax]]<ref name="pmid28045632">{{cite journal| author=Schwartz SR, Magit AE, Rosenfeld RM, Ballachanda BB, Hackell JM, Krouse HJ | display-authors=etal| title=Clinical Practice Guideline (Update): Earwax (Cerumen Impaction) Executive Summary | journal=Otolaryngol Head Neck Surg | year= 2017 | volume= 156 | issue= 1 | pages= 14-29 | pmid=28045632 | doi=10.1177/0194599816678832 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28045632  }} </ref>
*[[Foreign body]]<ref name="pmid23601480">{{cite journal| author=Conover K| title=Earache. | journal=Emerg Med Clin North Am | year= 2013 | volume= 31 | issue= 2 | pages= 413-42 | pmid=23601480 | doi=10.1016/j.emc.2013.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23601480  }} </ref>
*[[Foreign body]]<ref name="pmid23601480">{{cite journal| author=Conover K| title=Earache. | journal=Emerg Med Clin North Am | year= 2013 | volume= 31 | issue= 2 | pages= 413-42 | pmid=23601480 | doi=10.1016/j.emc.2013.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23601480  }} </ref>


====[[Otitis media]]<ref name="pmid2732519">{{cite journal| author=Teele DW, Klein JO, Rosner B| title=Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. | journal=J Infect Dis | year= 1989 | volume= 160 | issue= 1 | pages= 83-94 | pmid=2732519 | doi=10.1093/infdis/160.1.83 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2732519  }} </ref><ref name="pmid28707578">{{cite journal| author=Leung AKC, Wong AHC| title=Acute Otitis Media in Children. | journal=Recent Pat Inflamm Allergy Drug Discov | year= 2017 | volume= 11 | issue= 1 | pages= 32-40 | pmid=28707578 | doi=10.2174/1874609810666170712145332 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28707578  }} </ref><ref name="pmid24453496" />====
====Otitis media<ref name="pmid2732519">{{cite journal| author=Teele DW, Klein JO, Rosner B| title=Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective cohort study. | journal=J Infect Dis | year= 1989 | volume= 160 | issue= 1 | pages= 83-94 | pmid=2732519 | doi=10.1093/infdis/160.1.83 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2732519  }} </ref><ref name="pmid28707578">{{cite journal| author=Leung AKC, Wong AHC| title=Acute Otitis Media in Children. | journal=Recent Pat Inflamm Allergy Drug Discov | year= 2017 | volume= 11 | issue= 1 | pages= 32-40 | pmid=28707578 | doi=10.2174/1874609810666170712145332 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28707578  }} </ref><ref name="pmid24453496" />====


*C[[Common cold or upper respiratory tract infection|ommon cold or upper respiratory tract infection]] <ref name="pmid21918146">{{cite journal| author=Worrall G| title=Acute earache. | journal=Can Fam Physician | year= 2011 | volume= 57 | issue= 9 | pages= 1019-21, e320-2 | pmid=21918146 | doi= | pmc=3173423 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21918146  }} </ref>
*[[Common cold or upper respiratory tract infection, common cold or upper respiratory tract infection|Common cold or upper respiratory tract infection, common cold, or upper respiratory tract infection]] <ref name="pmid21918146">{{cite journal| author=Worrall G| title=Acute earache. | journal=Can Fam Physician | year= 2011 | volume= 57 | issue= 9 | pages= 1019-21, e320-2 | pmid=21918146 | doi= | pmc=3173423 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21918146  }} </ref>
*[[Streptococcus pneumoniae]]
*[[Streptococcus pneumoniae]]
*[[Nontypable Haemophilus influenzae]]
*[[Nontypable Haemophilus influenzae]]
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*[[Congenital ear anomalies(cleft palate)]]<ref name="pmid2140931">{{cite journal| author=Sando I, Takahashi H| title=Otitis media in association with various congenital diseases. Preliminary study. | journal=Ann Otol Rhinol Laryngol Suppl | year= 1990 | volume= 148 | issue=  | pages= 13-6 | pmid=2140931 | doi=10.1177/00034894900990s605 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2140931  }} </ref>
*[[Congenital ear anomalies(cleft palate)]]<ref name="pmid2140931">{{cite journal| author=Sando I, Takahashi H| title=Otitis media in association with various congenital diseases. Preliminary study. | journal=Ann Otol Rhinol Laryngol Suppl | year= 1990 | volume= 148 | issue=  | pages= 13-6 | pmid=2140931 | doi=10.1177/00034894900990s605 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2140931  }} </ref>


====[[Otitis media with effusion]]<ref name="pmid10944048">{{cite journal| author=Kubba H, Pearson JP, Birchall JP| title=The aetiology of otitis media with effusion: a review. | journal=Clin Otolaryngol Allied Sci | year= 2000 | volume= 25 | issue= 3 | pages= 181-94 | pmid=10944048 | doi=10.1046/j.1365-2273.2000.00350.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10944048  }} </ref><ref name="pmid24453496">{{cite journal| author=Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M| title=Update on otitis media - prevention and treatment. | journal=Infect Drug Resist | year= 2014 | volume= 7 | issue=  | pages= 15-24 | pmid=24453496 | doi=10.2147/IDR.S39637 | pmc=3894142 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24453496  }}</ref><ref name="pmid8229477">{{cite journal| author=Owen MJ, Baldwin CD, Swank PR, Pannu AK, Johnson DL, Howie VM| title=Relation of infant feeding practices, cigarette smoke exposure, and group child care to the onset and duration of otitis media with effusion in the first two years of life. | journal=J Pediatr | year= 1993 | volume= 123 | issue= 5 | pages= 702-11 | pmid=8229477 | doi=10.1016/s0022-3476(05)80843-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8229477  }}</ref>====
====Otitis media with effusion<ref name="pmid10944048">{{cite journal| author=Kubba H, Pearson JP, Birchall JP| title=The aetiology of otitis media with effusion: a review. | journal=Clin Otolaryngol Allied Sci | year= 2000 | volume= 25 | issue= 3 | pages= 181-94 | pmid=10944048 | doi=10.1046/j.1365-2273.2000.00350.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10944048  }} </ref><ref name="pmid24453496">{{cite journal| author=Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M| title=Update on otitis media - prevention and treatment. | journal=Infect Drug Resist | year= 2014 | volume= 7 | issue=  | pages= 15-24 | pmid=24453496 | doi=10.2147/IDR.S39637 | pmc=3894142 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24453496  }}</ref><ref name="pmid8229477">{{cite journal| author=Owen MJ, Baldwin CD, Swank PR, Pannu AK, Johnson DL, Howie VM| title=Relation of infant feeding practices, cigarette smoke exposure, and group child care to the onset and duration of otitis media with effusion in the first two years of life. | journal=J Pediatr | year= 1993 | volume= 123 | issue= 5 | pages= 702-11 | pmid=8229477 | doi=10.1016/s0022-3476(05)80843-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8229477  }}</ref>====


*Enter into group child care(Amounts of time spent)
*Enter into group child care (Amounts of time spent)
*Exposure of [[smoking]]
*Exposure of [[smoking]]
*Peroid of [[breastfeeding]]
*Period of [[breastfeeding]]


====Truma====
====Truma====
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*[[Air travel]]<ref name="pmid25599243">{{cite journal| author=Wright T| title=Middle-ear pain and trauma during air travel. | journal=BMJ Clin Evid | year= 2015 | volume= 2015 | issue=  | pages=  | pmid=25599243 | doi= | pmc=4298289 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25599243  }} </ref>
*[[Air travel]]<ref name="pmid25599243">{{cite journal| author=Wright T| title=Middle-ear pain and trauma during air travel. | journal=BMJ Clin Evid | year= 2015 | volume= 2015 | issue=  | pages=  | pmid=25599243 | doi= | pmc=4298289 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25599243  }} </ref>


===secondary otalgia===
===Secondary otalgia===


====[[Refered ear pain]]====
====Referred ear pain====


*[[Tonsillitis and Tonsillectomy]]<ref name="pmid30798778">{{cite journal| author=Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA | display-authors=etal| title=Clinical Practice Guideline: Tonsillectomy in Children (Update). | journal=Otolaryngol Head Neck Surg | year= 2019 | volume= 160 | issue= 1_suppl | pages= S1-S42 | pmid=30798778 | doi=10.1177/0194599818801757 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30798778  }}</ref><ref name="pmid20736106" /><ref name="pmid29365233" />
*[[Tonsillitis and Tonsillectomy]]<ref name="pmid30798778">{{cite journal| author=Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA | display-authors=etal| title=Clinical Practice Guideline: Tonsillectomy in Children (Update). | journal=Otolaryngol Head Neck Surg | year= 2019 | volume= 160 | issue= 1_suppl | pages= S1-S42 | pmid=30798778 | doi=10.1177/0194599818801757 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30798778  }}</ref><ref name="pmid20736106" /><ref name="pmid29365233" />
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*[[Toothaches]].
*[[Toothaches]].


*[[Sorethroat]].
*[[Mumps]]
*[[Mumps]]
*[[Dental infections]]
*[[Dental infections]]
*[[Temporomandibular joint disorder (TMJ)]] <ref name="pmid25822556">{{cite journal| author=Gauer RL, Semidey MJ| title=Diagnosis and treatment of temporomandibular disorders. | journal=Am Fam Physician | year= 2015 | volume= 91 | issue= 6 | pages= 378-86 | pmid=25822556 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25822556  }} </ref>


==Classification of otitis media==
==Classification of otitis media==


*[[Acute otitis media (AOM).]]<ref name="pmid25213276">{{cite journal| author=Rettig E, Tunkel DE| title=Contemporary concepts in management of acute otitis media in children. | journal=Otolaryngol Clin North Am | year= 2014 | volume= 47 | issue= 5 | pages= 651-72 | pmid=25213276 | doi=10.1016/j.otc.2014.06.006 | pmc=4393005 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25213276  }} </ref>
*Otitis media can be classified as the following:<ref name="pmid25213276">{{cite journal| author=Rettig E, Tunkel DE| title=Contemporary concepts in management of acute otitis media in children. | journal=Otolaryngol Clin North Am | year= 2014 | volume= 47 | issue= 5 | pages= 651-72 | pmid=25213276 | doi=10.1016/j.otc.2014.06.006 | pmc=4393005 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25213276  }} </ref>
*[[Recurrent acute otitis media (RAOM).]]
*[[Acute otitis media]] ([[AOM]]).
*[[Otitis media with effusion (OME).]]
*[[Recurrent otitis media|Recurrent acute otitis media]] ([[Recurrent otitis media|RAOM]]).
*[[Chronic otitis media with effusion (COME)]]
*[[OME|Otitis media with effusion]] ([[OME]]).
*[[Chronic otitis media|Chronic otitis media with effusion]] ([[Chronic otitis media|COME]])


==FIRE: Focused Initial Rapid Evaluation==
==FIRE: Focused Initial Rapid Evaluation==
Parents are considered as most reliable proxy for assessing [[ear pain]] at young children<ref name="pmid11533354">{{cite journal| author=American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health. Task Force on Pain in Infants, Children, and Adolescents| title=The assessment and management of acute pain in infants, children, and adolescents. | journal=Pediatrics | year= 2001 | volume= 108 | issue= 3 | pages= 793-7 | pmid=11533354 | doi=10.1542/peds.108.3.793 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11533354  }} </ref> . If child come with  [[restless sleep]], [[ear rubbing,]] [[irritability]], excessive [[crying]], decreased activity, [[poor appetite]] and may be with [[fever]] we should think about [[ear pain]] .the help us to know the cause of [[ear pain]] is examination by [[otoscopy]] reveals the [[tympanic membrane]] if its [[bulging]], [[retraction]],[[fluid behind]] the [[eardrum]] or there is [[foreign body]]<ref name="pmid30572868">{{cite journal| author=Uitti JM, Salanterä S, Laine MK, Tähtinen PA, Ruohola A| title=Adaptation of pain scales for parent observation: are pain scales and symptoms useful in detecting pain of young children with the suspicion of acute otitis media? | journal=BMC Pediatr | year= 2018 | volume= 18 | issue= 1 | pages= 392 | pmid=30572868 | doi=10.1186/s12887-018-1361-y | pmc=6302518 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30572868  }} </ref>.
Parents are considered as the most reliable proxy for assessing [[ear pain]] at young children<ref name="pmid11533354">{{cite journal| author=American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health. Task Force on Pain in Infants, Children, and Adolescents| title=The assessment and management of acute pain in infants, children, and adolescents. | journal=Pediatrics | year= 2001 | volume= 108 | issue= 3 | pages= 793-7 | pmid=11533354 | doi=10.1542/peds.108.3.793 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11533354  }} </ref> . If child come with  [[restless sleep]], [[ear rubbing,]] [[irritability]], excessive [[crying]], decreased activity, [[poor appetite]] and may be with [[fever]] we should think about [[ear pain]] .the help us to know the cause of [[ear pain]] is examination by [[otoscopy]] reveals the [[tympanic membrane]] if its [[bulging]], [[retraction]],[[fluid behind]] the [[eardrum]] o [[eardrum|it]][[eardrum|f]]  there is [[foreign body]]<ref name="pmid30572868">{{cite journal| author=Uitti JM, Salanterä S, Laine MK, Tähtinen PA, Ruohola A| title=Adaptation of pain scales for parent observation: are pain scales and symptoms useful in detecting pain of young children with the suspicion of acute otitis media? | journal=BMC Pediatr | year= 2018 | volume= 18 | issue= 1 | pages= 392 | pmid=30572868 | doi=10.1186/s12887-018-1361-y | pmc=6302518 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30572868  }} </ref>.


'''Ear pain'''<ref name="pmid18350760">{{cite journal| author=Ely JW, Hansen MR, Clark EC| title=Diagnosis of ear pain. | journal=Am Fam Physician | year= 2008 | volume= 77 | issue= 5 | pages= 621-8 | pmid=18350760 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18350760  }} </ref>
'''Ear pain'''<ref name="pmid18350760">{{cite journal| author=Ely JW, Hansen MR, Clark EC| title=Diagnosis of ear pain. | journal=Am Fam Physician | year= 2008 | volume= 77 | issue= 5 | pages= 621-8 | pmid=18350760 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18350760  }} </ref>
Line 93: Line 98:
**secondary otalgia.
**secondary otalgia.


*imaging studies.
*Imaging studies.


IF Diagnosis is not clear from the history and physical examination.
The IF Diagnosis is not clear from the history and physical examination.
==Complete Diagnostic Approach==
==Complete Diagnostic Approach==
{{familytree/start |summary=Fatigue.}}
{{familytree/start |summary=Fatigue.}}
{{familytree | | | | | | | | | | | | | A01 | | | A01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Characterize the pain'''
{{familytree | | | | | | | | | | | | | A01 | | | A01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Characterize the pain'''
*Usually the parents use [[pain scale]]<nowiki/>s to detect pain in their young children .<ref name="pmid30572868">{{cite journal| author=Uitti JM, Salanterä S, Laine MK, Tähtinen PA, Ruohola A| title=Adaptation of pain scales for parent observation: are pain scales and symptoms useful in detecting pain of young children with the suspicion of acute otitis media? | journal=BMC Pediatr | year= 2018 | volume= 18 | issue= 1 | pages= 392 | pmid=30572868 | doi=10.1186/s12887-018-1361-y | pmc=6302518 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30572868  }} </ref>
*Usually the parents use [[pain scale]]<nowiki/>s to detect pain in their young children .<ref name="pmid30572868">{{cite journal| author=Uitti JM, Salanterä S, Laine MK, Tähtinen PA, Ruohola A| title=Adaptation of pain scales for parent observation: are pain scales and symptoms useful in detecting pain of young children with suspicion of acute otitis media? | journal=BMC Pediatr | year= 2018 | volume= 18 | issue= 1 | pages= 392 | pmid=30572868 | doi=10.1186/s12887-018-1361-y | pmc=6302518 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30572868  }} </ref>
*''Ear-related symptoms: ear rubbing.''
*''Ear-related symptoms: ear rubbing.''
*''Non-specific symptoms'': fever, irritability, [[excessive crying,]] decreased activity, poor appetite and restless sleep.
*''Non-specific symptoms'': fever, irritability, [[excessive crying,]] decreased activity, poor appetite, and restless sleep.
*''Respiratory symptoms'': rhinitis, cough, hoarse voice, conjunctivitis, mucus vomiting and  n[[asal congestion]].
*''Respiratory symptoms'': rhinitis, cough, hoarse voice, conjunctivitis, mucus vomiting, and  n[[asal congestion]].
*''Gastrointestinal symptoms'': [[vomiting, and diarrhea]].</div> }}
*''Gastrointestinal symptoms'': [[vomiting, and diarrhea]].</div> }}
{{familytree | | | | | | | | | | | | | |!| | | | | | }}
{{familytree | | | | | | | | | | | | | |!| | | | | | }}
{{familytree | | | | | | | | | | | | | B01 | | | B01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''History'''
{{familytree | | | | | | | | | | | | | B01 | | | B01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''History'''
*Enter into group child care and amounts of time spent.
*Enter into group child care and amounts of time spent.
*Exposure of smoking.
*The exposure of smoking.
*Period of [[breastfeeding.]]
*Period of [[breastfeeding.]]
*[[Swimming]]
*[[Swimming]]
Line 119: Line 124:
It does not do for children who have been diagnosed on the basis of assessment in the clinic. <ref name="pmid14962529">{{cite journal| author=Rovers MM, Schilder AG, Zielhuis GA, Rosenfeld RM| title=Otitis media. | journal=Lancet | year= 2004 | volume= 363 | issue= 9407 | pages= 465-73 | pmid=14962529 | doi=10.1016/S0140-6736(04)15495-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14962529  }} </ref> <ref name="pmid24453496">{{cite journal| author=Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M| title=Update on otitis media - prevention and treatment. | journal=Infect Drug Resist | year= 2014 | volume= 7 | issue=  | pages= 15-24 | pmid=24453496 | doi=10.2147/IDR.S39637 | pmc=3894142 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24453496  }} </ref>  
It does not do for children who have been diagnosed on the basis of assessment in the clinic. <ref name="pmid14962529">{{cite journal| author=Rovers MM, Schilder AG, Zielhuis GA, Rosenfeld RM| title=Otitis media. | journal=Lancet | year= 2004 | volume= 363 | issue= 9407 | pages= 465-73 | pmid=14962529 | doi=10.1016/S0140-6736(04)15495-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14962529  }} </ref> <ref name="pmid24453496">{{cite journal| author=Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M| title=Update on otitis media - prevention and treatment. | journal=Infect Drug Resist | year= 2014 | volume= 7 | issue=  | pages= 15-24 | pmid=24453496 | doi=10.2147/IDR.S39637 | pmc=3894142 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24453496  }} </ref>  
*[[Tympanic membrane.]]
*[[Tympanic membrane.]]
If the [[tympanic membrane]] is abnormal the most cause of it by [[primary otalgia]]. The most cause of primary otalgia include
If the [[tympanic membrane]] is abnormal, the most likely cause of it by [[primary otalgia]]. The main causes of primary otalgia include
*[[Acute otitis media.]]
*[[Acute otitis media.]]
**[[Cloudy]], bulging PMID: 22459064 erythema  of the [[tympanic membrane]].<ref name="pmid24453496">{{cite journal| author=Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M| title=Update on otitis media - prevention and treatment. | journal=Infect Drug Resist | year= 2014 | volume= 7 | issue=  | pages= 15-24 | pmid=24453496 | doi=10.2147/IDR.S39637 | pmc=3894142 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24453496  }} </ref>
**[[Cloudy]], bulging PMID: 22459064 erythema  of the [[tympanic membrane]].<ref name="pmid24453496">{{cite journal| author=Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M| title=Update on otitis media - prevention and treatment. | journal=Infect Drug Resist | year= 2014 | volume= 7 | issue=  | pages= 15-24 | pmid=24453496 | doi=10.2147/IDR.S39637 | pmc=3894142 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24453496  }} </ref>
**Acute onset symptoms and signs [[fever]], [[otalgia]]  also see [[irritability]], [[otorrhea]], [[anorexia]], and [[vomiting]].
**Acute onset symptoms and signs [[fever]], [[otalgia]]  also see [[irritability]], [[otorrhea]], [[anorexia]], and [[vomiting]].
**Usually affects children aged under 2 years,
**It usually affects children aged under 2 years,
*Otitis media with effusion.
*Otitis media with effusion.
**Retracted/concave [[tympanic membrane]] with change colour of [[tympanic membrane]] (yellow,amber,blue) , and [[air–fluid levels]].<ref name="pmid24453496">{{cite journal| author=Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M| title=Update on otitis media - prevention and treatment. | journal=Infect Drug Resist | year= 2014 | volume= 7 | issue=  | pages= 15-24 | pmid=24453496 | doi=10.2147/IDR.S39637 | pmc=3894142 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24453496  }} </ref>
**Retracted/concave [[tympanic membrane]] with change colour of [[tympanic membrane]] (yellow,amber,blue) , and [[air–fluid levels]].<ref name="pmid24453496">{{cite journal| author=Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M| title=Update on otitis media - prevention and treatment. | journal=Infect Drug Resist | year= 2014 | volume= 7 | issue=  | pages= 15-24 | pmid=24453496 | doi=10.2147/IDR.S39637 | pmc=3894142 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24453496  }} </ref>
**Absence of signs and symptoms (asymptomatic).
**Absence of signs and symptoms (asymptomatic).
**[[Hearing loss]].This is lead to [[speech delays]].It is detected on screening of asymptomatic children.<ref name="pmid27604644">{{cite journal| author=Schilder AG, Chonmaitree T, Cripps AW, Rosenfeld RM, Casselbrant ML, Haggard MP | display-authors=etal| title=Otitis media. | journal=Nat Rev Dis Primers | year= 2016 | volume= 2 | issue=  | pages= 16063 | pmid=27604644 | doi=10.1038/nrdp.2016.63 | pmc=7097351 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27604644  }} </ref> <ref name="pmid24453496">{{cite journal| author=Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M| title=Update on otitis media - prevention and treatment. | journal=Infect Drug Resist | year= 2014 | volume= 7 | issue=  | pages= 15-24 | pmid=24453496 | doi=10.2147/IDR.S39637 | pmc=3894142 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24453496  }} </ref>
**[[Hearing loss]].This is lead to [[speech delays]].It is detected during screening of asymptomatic children.<ref name="pmid27604644">{{cite journal| author=Schilder AG, Chonmaitree T, Cripps AW, Rosenfeld RM, Casselbrant ML, Haggard MP | display-authors=etal| title=Otitis media. | journal=Nat Rev Dis Primers | year= 2016 | volume= 2 | issue=  | pages= 16063 | pmid=27604644 | doi=10.1038/nrdp.2016.63 | pmc=7097351 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27604644  }} </ref> <ref name="pmid24453496">{{cite journal| author=Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M| title=Update on otitis media - prevention and treatment. | journal=Infect Drug Resist | year= 2014 | volume= 7 | issue=  | pages= 15-24 | pmid=24453496 | doi=10.2147/IDR.S39637 | pmc=3894142 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24453496  }} </ref>
**Affects children between 3 and 7 years old.
**Affects children between 3 and 7 years old.
*Chronic [[otitis media]] with [[effusion]].
*Chronic [[otitis media]] with [[effusion]].
**Persiste of acute otitis media  for ≥3 mo from the date of onset.
**Persistent of acute otitis media  for ≥3 mo from the date of onset.
**Tympanic membrane perforation and associated middle [[ear discharge]].
**Tympanic membrane perforation and the associated middle [[ear discharge]].
*[[Recurrent acute otitis media.]]
*[[Recurrent acute otitis media.]]
**Child has three episodes of acute otitis media within a 6-month period, or four in one year.
*A child has three episodes of acute otitis media within a 6-month period or four in one year.
*[[Otitis externa]] ([[swimmer's ear]]). <ref name="pmid23198673">{{cite journal| author=Schaefer P, Baugh RF| title=Acute otitis externa: an update. | journal=Am Fam Physician | year= 2012 | volume= 86 | issue= 11 | pages= 1055-61 | pmid=23198673 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23198673  }} </ref>
*[[Otitis externa]] ([[swimmer's ear]]). <ref name="pmid23198673">{{cite journal| author=Schaefer P, Baugh RF| title=Acute otitis externa: an update. | journal=Am Fam Physician | year= 2012 | volume= 86 | issue= 11 | pages= 1055-61 | pmid=23198673 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23198673  }} </ref>
**Inflammation at the [[External ea|external ear canal,erythem]]<nowiki/>a and edema this lead to narrow it also may be involve the [[pinna]] or [[tympanic membrane]].
**Inflammation at the [[External ea|external ear canal,erythem]]<nowiki/>a and edema this lead to narrow it also may involve the [[pinna]] or [[tympanic membrane]].
**[[Ear pain]] ,[[hearing loss]], [[itching]], and [[otorrhea]].
**[[Ear pain]] ,[[hearing loss]], [[itching]], and [[otorrhea]].
*[[Ear wax.]]<ref name="pmid19450340">{{cite journal| author=Browning GG| title=Ear wax. | journal=BMJ Clin Evid | year= 2008 | volume= 2008 | issue=  | pages=  | pmid=19450340 | doi= | pmc=2907972 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19450340  }} </ref>
*[[Ear wax.]]<ref name="pmid19450340">{{cite journal| author=Browning GG| title=Ear wax. | journal=BMJ Clin Evid | year= 2008 | volume= 2008 | issue=  | pages=  | pmid=19450340 | doi= | pmc=2907972 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19450340  }} </ref>
**See wax.
**See wax.
**[[Hearing loss]], [[itching]], [[pain]], [[tinnitus]]. <ref name="pmid30277727">{{cite journal| author=Michaudet C, Malaty J| title=Cerumen Impaction: Diagnosis and Management. | journal=Am Fam Physician | year= 2018 | volume= 98 | issue= 8 | pages= 525-529 | pmid=30277727 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30277727  }} </ref></div> }}
**[[Hearing loss]], [[itching]], [[pain]], [[tinnitus]]. <ref name="pmid30277727">{{cite journal| author=Michaudet C, Malaty J| title=Cerumen Impaction: Diagnosis and Management. | journal=Am Fam Physician | year= 2018 | volume= 98 | issue= 8 | pages= 525-529 | pmid=30277727 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30277727  }} </ref></div> }}
 
==Treatment==
=Table=
=Table=
Key differences in the 2004 and 2013 American Academy of Pediatrics guidelines for the diagnosis and management of acute otitis media (AOM)<ref name="pmid25213276">{{cite journal| author=Rettig E, Tunkel DE| title=Contemporary concepts in management of acute otitis media in children. | journal=Otolaryngol Clin North Am | year= 2014 | volume= 47 | issue= 5 | pages= 651-72 | pmid=25213276 | doi=10.1016/j.otc.2014.06.006 | pmc=4393005 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25213276  }} </ref>
Key differences in the 2004 and 2013 American Academy of Pediatrics guidelines for the diagnosis and management of acute otitis media (AOM)<ref name="pmid25213276">{{cite journal| author=Rettig E, Tunkel DE| title=Contemporary concepts in management of acute otitis media in children. | journal=Otolaryngol Clin North Am | year= 2014 | volume= 47 | issue= 5 | pages= 651-72 | pmid=25213276 | doi=10.1016/j.otc.2014.06.006 | pmc=4393005 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25213276  }} </ref>
Line 160: Line 165:
| colspan="1" rowspan="1" |Acute onset of signs and symptoms
| colspan="1" rowspan="1" |Acute onset of signs and symptoms
| colspan="1" rowspan="1" |Moderate to severe bulging of TM, or new-onset otorrhea not owing to acute otitis externa
| colspan="1" rowspan="1" |Moderate to severe bulging of TM, or new-onset otorrhea not owing to acute otitis externa
| colspan="1" rowspan="3" |2004 criteria allowed less precise diagnosis, provided treatment recommendation when diagnosis was uncertain.
| colspan="1" rowspan="3" |2004 criteria allowed less precise diagnosis and provided treatment recommendation when diagnosis was uncertain.
|-
|-
| colspan="1" rowspan="1" |Presence of MEE
| colspan="1" rowspan="1" |Presence of MEE
| colspan="1" rowspan="1" |Mild bulging of TM and recentb onset ear painc or intense TM erythema
| colspan="1" rowspan="1" |Mild bulging of TM and recent onset ear pain and intense TM erythema
|-
|-
| colspan="1" rowspan="1" |Signs and symptoms of middle ear inflammationa
| colspan="1" rowspan="1" |Signs and symptoms of middle ear inflammationa
Line 179: Line 184:
----
----
|-
|-
| colspan="1" rowspan="2" |Initial observation option instead of initial antibiotic therapy
| colspan="1" rowspan="2" |Initial observation option instead of the initial antibiotic therapy
| colspan="1" rowspan="1" |Option for observation:
| colspan="1" rowspan="1" |Option for observation:


*6 mo–2 y: Option if uncertain diagnosis and nonsevere illnessd
*6 mo–2 y: Option if uncertain diagnosis or non-severe illness
*≥2 y: Option if nonsevered and certain diagnosis
*≥2 y: Option if nonsevered and certain diagnosis
| colspan="1" rowspan="1" |Option for observation:
| colspan="1" rowspan="1" |Option for observation:
Line 196: Line 201:


*None
*None
| colspan="1" rowspan="1" |Evidence of small benefit of antibiotics in recent trials that used stringent diagnostic criteria.
| colspan="1" rowspan="1" |Evidence of the small benefits of antibiotics in recent trials that used stringent diagnostic criteria.
|-
|-
| colspan="4" rowspan="1" |
| colspan="4" rowspan="1" |
Line 205: Line 210:


*<6 mo: All cases
*<6 mo: All cases
*6 mo–2 y: Certain diagnosis, or uncertain diagnosis if severee illness
*6 mo–2 y: Certain diagnosis, or uncertain diagnosis if severe illness
*≥2 y: Certain diagnosis and severee illness
*≥2 y: Certain diagnosis and severe illness
| colspan="1" rowspan="1" |Antibiotics recommended:
| colspan="1" rowspan="1" |Antibiotics recommended:


*6 mo–2 y: Otorrhea or severee illness or bilateral without otorrhea
*6 mo–2 y: Otorrhea or severe illness or bilateral without otorrhea
*≥2 y: Otorrhea or severee illness
*≥2 y: Otorrhea or severe illness
| colspan="1" rowspan="1" |More stringent diagnostic guidelines in 2013 should lead to greater antibiotic benefit.
| colspan="1" rowspan="1" |More stringent diagnostic guidelines in 2013 should lead to greater antibiotic benefit.
|-
|-
| colspan="1" rowspan="1" |Antibiotics an option:
| colspan="1" rowspan="1" |Antibiotics an option:


*6 mo–2 y: Uncertain diagnosis and nonsevered illness
*6 mo–2 y: Uncertain diagnosis and non-severed illness
*≥2 y: Certain diagnosis and nonsevered illness
*≥2 y: Certain diagnosis and nonsevered illness
| colspan="1" rowspan="1" |Antibiotics an option:
| colspan="1" rowspan="1" |Antibiotics an option:
Line 240: Line 245:
''Abbreviations:'' MEE, middle ear effusion; TM, tympanic membrane.
''Abbreviations:'' MEE, middle ear effusion; TM, tympanic membrane.


aSigns and symptoms of middle ear inflammation include distinct erythema of TM or distinct otalgia (‘discomfort clearly referable to the ear[s] that results in interference with or precludes normal activity or sleep’).
Signs and symptoms of middle ear inflammation include distinct erythema of TM or distinct otalgia (‘discomfort clearly referable to the ear's) that results in interference with or precludes normal activity or sleep’).


bRecent: <48 hours.
bRecent: <48 hours.


cEar pain may be indicated by holding, tugging, or rubbing of the ear in a nonverbal child.
Ear pain may be indicated by holding, tugging, or rubbing of the ear in a nonverbal child.


dNonsevere illness defined as mild otalgia and fever <39°C in the past 24 hours in the 2004 guideline; the 2013 guideline modifies this to “mild otalgia for less than 48 hours and temperature less than 39°C.”
non-severe illness was defined as mild otalgia and fever <39°C in the past 24 hours in the 2004 guideline; the 2013 guideline modifies this to “mild otalgia for less than 48 hours and a temperature of less than 39°C.”


eSevere signs or symptoms include moderate or severe otalgia or temperature ≥39°C in 2004 guideline; the 2013 guideline also includes otalgia for ≥48 hours.
Severe signs or symptoms include moderate or severe otalgia or temperature ≥39°C in 2004 guidelines; the 2013 guideline also includes otalgia for ≥48 hours.


''Adapted from'' Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics 2013;131(3):e964–99; and American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics 2004;113(5):1451–65.
''Adapted from'' Lieberthal AS, Carroll AE, Chonmaitree T, et al. diagnosis and management of acute otitis media. Pediatrics 2013;131(3):e964–99; and American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics 2004;113(5):1451–65
 
 
 
 
==Treatment==
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*[[Acut otitis media]].
**In general,approximately 80% of children have spontaneous relief of AOM within 2–14 days who absence of suspected complications it follow initial treatment of symptomatic ([[analgesia]] and [[antipyretics]]) as [[fever]] and e[[ar pain]].If severe,recurrent infections or persistent give antibioticor if there is complication may offer tympanostomy tubes.<ref name="pmid24453496">{{cite journal| author=Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M| title=Update on otitis media - prevention and treatment. | journal=Infect Drug Resist | year= 2014 | volume= 7 | issue=  | pages= 15-24 | pmid=24453496 | doi=10.2147/IDR.S39637 | pmc=3894142 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24453496  }}</ref>
**If we use [[analgisic]].<ref name="pmid25213276">{{cite journal| author=Rettig E, Tunkel DE| title=Contemporary concepts in management of acute otitis media in children. | journal=Otolaryngol Clin North Am | year= 2014 | volume= 47 | issue= 5 | pages= 651-72 | pmid=25213276 | doi=10.1016/j.otc.2014.06.006 | pmc=4393005 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25213276  }} </ref>
***Oral [[acetaminophen]] and [[ibuprofen]] are commonly used to treat [[pain]] in children.<ref name="pmid8871138">{{cite journal| author=Bertin L, Pons G, d'Athis P, Duhamel JF, Maudelonde C, Lasfargues G | display-authors=etal| title=A randomized, double-blind, multicentre controlled trial of ibuprofen versus acetaminophen and placebo for symptoms of acute otitis media in children. | journal=Fundam Clin Pharmacol | year= 1996 | volume= 10 | issue= 4 | pages= 387-92 | pmid=8871138 | doi=10.1111/j.1472-8206.1996.tb00590.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8871138  }} </ref>
**If we use [[antibiotics]].<ref name="pmid25213276">{{cite journal| author=Rettig E, Tunkel DE| title=Contemporary concepts in management of acute otitis media in children. | journal=Otolaryngol Clin North Am | year= 2014 | volume= 47 | issue= 5 | pages= 651-72 | pmid=25213276 | doi=10.1016/j.otc.2014.06.006 | pmc=4393005 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25213276  }} </ref>
***[[Amoxicillin]] (90 mg/kg per day) is the recommended first-line agent in the 2013 guidelines.
***[[Amoxicillin]] with [[beta-lactamase]] coverage the patient has concurrent purulent conjunctivitis or recurrent [[acut otitis media]] unresponsive to [[amoxicillin.]]
***If there is [[penicillin]]-sensitive patients we can use second- or third-generation [[cephalosporins]], including intramuscular [[ceftriaxone]] or if penicillin-sensitive patients or [[amoxicillin]] failures we can use second- and third-generation [[cephalosporin]]<nowiki/>s and [[clindamycin.]]
***[[Tympanocentesis]] use for drainage (theraby) and culture in difficult cases.
*[[Acute otitis externa]].<ref name="pmid23198673">{{cite journal| author=Schaefer P, Baugh RF| title=Acute otitis externa: an update. | journal=Am Fam Physician | year= 2012 | volume= 86 | issue= 11 | pages= 1055-61 | pmid=23198673 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23198673  }} </ref>
**American guidelines promote initial ototopical therapy without systemic [[antibiotics f]]<nowiki/>or uncomplicated acute otitis externa such as [[topical antibiotics]] with or witout topical [[corticosteroids]].
**Oral [[antibiotics]] use for infection has spread beyond the ear canal.
*[[Ear wax]]
**First-line treatmen is softening [[ear drops]] (oil or water).<ref name="pmid30043448">{{cite journal| author=Aaron K, Cooper TE, Warner L, Burton MJ| title=Ear drops for the removal of ear wax. | journal=Cochrane Database Syst Rev | year= 2018 | volume= 7 | issue=  | pages= CD012171 | pmid=30043448 | doi=10.1002/14651858.CD012171.pub2 | pmc=6492540 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30043448  }} </ref>  <ref name="pmid26484488">{{cite journal| author=Poulton S, Yau S, Anderson D, Bennett D| title=Ear wax management. | journal=Aust Fam Physician | year= 2015 | volume= 44 | issue= 10 | pages= 731-4 | pmid=26484488 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26484488  }} </ref>
**[[Ear syringing]].


{{Family tree/start}}
{{Family tree | | | | | B01 | | | |B01=<div style="float: left; text-align: left; width: 10em; padding:1em;">'''Treat the underlying causes'''  }}
{{Family tree | |,|-|-|-|+|-|-|-|v|-|-|-|v|-|-|-|.| }}
{{Family tree | C01 | | C02 | | C03 | | C04 | | C05 |C01=<div style="float: left; text-align: left; width: 10em; padding:1em;">''' Fatigue due to Acut otitis media
❑In general,approximately 80% of children have spontaneous relief AOM within 2–14 days who absence of suspected complications follows initial treatment of symptomatic ([[analgesia]] and [[antipyretics]]) as [[fever]] and e[[ar pain]].If severe,recurrent infections or persistent give antibioticor if there is complication may offer tympanostomy tubes.<ref name="pmid24453496">{{cite journal| author=Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M| title=Update on otitis media - prevention and treatment. | journal=Infect Drug Resist | year= 2014 | volume= 7 | issue=  | pages= 15-24 | pmid=24453496 | doi=10.2147/IDR.S39637 | pmc=3894142 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24453496  }}</ref><br>
❑If we use analgisic<ref name="pmid25213276">{{cite journal| author=Rettig E, Tunkel DE| title=Contemporary concepts in the management of acute otitis media in children. | journal=Otolaryngol Clin North Am | year= 2014 | volume= 47 | issue= 5 | pages= 651-72 | pmid=25213276 | doi=10.1016/j.otc.2014.06.006 | pmc=4393005 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25213276  }} </ref>Oral [[acetaminophen]] and [[ibuprofen]] are commonly used to treat [[pain]] in children.<ref name="pmid8871138">{{cite journal| author=Bertin L, Pons G, d'Athis P, Duhamel JF, Maudelonde C, Lasfargues G | display-authors=etal| title=A randomized, double-blind, multicentre trial of ibuprofen versus acetaminophen and placebo for symptoms of acute otitis media in children. | journal=Fundam Clin Pharmacol | year= 1996 | volume= 10 | issue= 4 | pages= 387-92 | pmid=8871138 | doi=10.1111/j.1472-8206.1996.tb00590.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8871138  }} </ref><br>
❑ If we use [[antibiotics]].<ref name="pmid25213276">{{cite journal| author=Rettig E, Tunkel DE| title=Contemporary concepts in management of acute otitis media in children. | journal=Otolaryngol Clin North Am | year= 2014 | volume= 47 | issue= 5 | pages= 651-72 | pmid=25213276 | doi=10.1016/j.otc.2014.06.006 | pmc=4393005 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25213276  }} </ref>
*[[Amoxicillin]] (90 mg/kg per day) is the recommended first-line agent in the 2013 guidelines.
*[[Amoxicillin]] with [[beta-lactamase]] coverage the patient has concurrent purulent conjunctivitis or recurrent [[acut otitis media]] unresponsive to [[amoxicillin.]]
*If there is [[penicillin]]-sensitive patients we can use second- or third-generation [[cephalosporins]], including intramuscular [[ceftriaxone]] or if penicillin-sensitive patients or [[amoxicillin]] failures we can use second- and third-generation [[cephalosporin]]<nowiki/>s and [[clindamycin.]]
*[[Tympanocentesis]] use for drainage (theraby) and culture in difficult cases| C02=<div style="float: left; text-align: left; width: 10em; padding:1em;">''' Fatigue due toAcute otitis externa<ref name="pmid23198673">{{cite journal| author=Schaefer P, Baugh RF| title=Acute otitis externa: an update. | journal=Am Fam Physician | year= 2012 | volume= 86 | issue= 11 | pages= 1055-61 | pmid=23198673 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23198673  }} </ref>
❑American guidelines promote initial ototopical therapy without systemic antibiotics for uncomplicated acute otitis externa such as topical antibiotics with or without topical corticosteroids.
❑Oral antibiotics use for infection have spread beyond the ear canal.  | C03=<div style="float: left; text-align: left; width: 10em; padding:1em;">''' Fatigue due to Otitis media with effusion.
❑Antibiotics, histamines or decongestants not effect at treatment<ref name="pmid21901683">{{cite journal| author=Griffin G, Flynn CA| title=Antihistamines and/or decongestants for otitis media with effusion (OME) in children. | journal=Cochrane Database Syst Rev | year= 2011 | volume=  | issue= 9 | pages= CD003423 | pmid=21901683 | doi=10.1002/14651858.CD003423.pub3 | pmc=7170417 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21901683  }} </ref>
❑In less sever case and without hearing problems, the effusion can resolve spontaneously or with autoinflation <ref name="pmid8365006">{{cite journal| author=Blanshard JD, Maw AR, Bawden R| title=Conservative treatment of otitis media with effusion by autoinflation of the middle ear. | journal=Clin Otolaryngol Allied Sci | year= 1993 | volume= 18 | issue= 3 | pages= 188-92 | pmid=8365006 | doi=10.1111/j.1365-2273.1993.tb00827.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8365006  }} </ref>
❑In sever case or persistent symptomatic cases, the treatment is by tympanostomy with or without adenoidectomy.<ref name="pmid20927726">{{cite journal| author=Browning GG, Rovers MM, Williamson I, Lous J, Burton MJ| title=Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. | journal=Cochrane Database Syst Rev | year= 2010 | volume=  | issue= 10 | pages= CD001801 | pmid=20927726 | doi=10.1002/14651858.CD001801.pub3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20927726  }} </ref><ref name="pmid25913597">{{cite journal| author=Atkinson H, Wallis S, Coatesworth AP| title=Otitis media with effusion. | journal=Postgrad Med | year= 2015 | volume= 127 | issue= 4 | pages= 381-5 | pmid=25913597 | doi=10.1080/00325481.2015.1028317 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25913597  }} </ref>  | C04=<div style="float: left; text-align: left; width: 10em; padding:1em;">''' Fatigue due to  Tonsilitis
❑Treatment depends on the cause.<br>
❑IF the cause is viral it is go by alone.<ref name="urlTonsillitis | Tonsillitis Symptoms | Tonsillitis Treatment | MedlinePlus">{{cite web |url=+https://medlineplus.gov/tonsillitis.html |title=Tonsillitis &#124; Tonsillitis Symptoms &#124; Tonsillitis Treatment &#124; MedlinePlus |format= |work= |accessdate=}}</ref>
❑Antibiotics.
*If the cause is group A streptococcus, the first-line therapy antibiotics are used is penicillin or amoxicillin<ref name="pmid25418818">{{cite journal| author=Bird JH, Biggs TC, King EV| title=Controversies in the review of acute tonsillitis: an evidence-based review. | journal=Clin Otolaryngol | year= 2014 | volume= 39 | issue= 6 | pages= 368-74 | pmid=25418818 | doi=10.1111/coa.12299 | pmc=7162355 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25418818  }} </ref><ref name="pmid1459378">{{cite journal| author=Touw-Otten FW, Johansen KS| title=Diagnosis, antibiotic treatment and outcome of acute tonsillitis: report of a WHO Regional Office for Europe study in 17 European countries. | journal=Fam Pract | year= 1992 | volume= 9 | issue= 3 | pages= 255-62 | pmid=1459378 | doi=10.1093/fampra/9.3.255 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1459378  }} </ref> .If there is alergic to pinicillin  we can use a macrolide <ref name="pmid15060239">{{cite journal| author=Casey JR, Pichichero ME| title=Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children. | journal=Pediatrics | year= 2004 | volume= 113 | issue= 4 | pages= 866-82 | pmid=15060239 | doi=10.1542/peds.113.4.866 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15060239  }} </ref>.If there is no response to penicillin therapy, we can use clindamycin or amoxicillin-clavulanate<ref name="pmid20003454">{{cite journal| author=Brook I| title=The role of beta-lactamase-producing-bacteria in mixed infections. | journal=BMC Infect Dis | year= 2009 | volume= 9 | issue=  | pages= 202 | pmid=20003454 | doi=10.1186/1471-2334-9-202 | pmc=2804585 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20003454  }} </ref> .
❑Pain medication.
❑Surgery.
*Tonsillectomy<ref name="pmid25407135">{{cite journal| author=Burton MJ, Glasziou PP, Chong LY, Venekamp RP| title=Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. | journal=Cochrane Database Syst Rev | year= 2014 | volume=  | issue= 11 | pages= CD001802 | pmid=25407135 | doi=10.1002/14651858.CD001802.pub3 | pmc=7075105 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25407135  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=25736043 Review in: Evid Based Med. 2015 Apr;20(2):64] </ref> . It is as a choice for treatment the chronic tonsillitis  |C05=<div style="float: left; text-align: left; width: 10em; padding:1em;">''' Fatigue due to  Ear wax
❑First-line treatmen is softening [[ear drops]] (oil or water).<ref name="pmid30043448">{{cite journal| author=Aaron K, Cooper TE, Warner L, Burton MJ| title=Ear drops for the removal of ear wax. | journal=Cochrane Database Syst Rev | year= 2018 | volume= 7 | issue=  | pages= CD012171 | pmid=30043448 | doi=10.1002/14651858.CD012171.pub2 | pmc=6492540 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30043448  }} </ref>  <ref name="pmid26484488">{{cite journal| author=Poulton S, Yau S, Anderson D, Bennett D| title=Ear wax management. | journal=Aust Fam Physician | year= 2015 | volume= 44 | issue= 10 | pages= 731-4 | pmid=26484488 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26484488  }} </ref>
❑Ear syringing. }}
{{Family tree/end}}
==Do's==
==Do's==


*[[Vaccine]]
*Otitis media
**[[Pneumococcal vaccine]] prevent [[otitis media]].<ref name="pmid24453496">{{cite journal| author=Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M| title=Update on otitis media - prevention and treatment. | journal=Infect Drug Resist | year= 2014 | volume= 7 | issue=  | pages= 15-24 | pmid=24453496 | doi=10.2147/IDR.S39637 | pmc=3894142 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24453496  }} </ref>
**[[Vaccine]]
***[[Pneumococcal vaccine]] prevents otitis media.<ref name="pmid24453496">{{cite journal| author=Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M| title=Update on otitis media - prevention and treatment. | journal=Infect Drug Resist | year= 2014 | volume= 7 | issue=  | pages= 15-24 | pmid=24453496 | doi=10.2147/IDR.S39637 | pmc=3894142 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24453496  }} </ref>
*[[Breastfeeding]].<ref name="pmid25213276">{{cite journal| author=Rettig E, Tunkel DE| title=Contemporary concepts in management of acute otitis media in children. | journal=Otolaryngol Clin North Am | year= 2014 | volume= 47 | issue= 5 | pages= 651-72 | pmid=25213276 | doi=10.1016/j.otc.2014.06.006 | pmc=4393005 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25213276  }} </ref>
*[[Breastfeeding]].<ref name="pmid25213276">{{cite journal| author=Rettig E, Tunkel DE| title=Contemporary concepts in management of acute otitis media in children. | journal=Otolaryngol Clin North Am | year= 2014 | volume= 47 | issue= 5 | pages= 651-72 | pmid=25213276 | doi=10.1016/j.otc.2014.06.006 | pmc=4393005 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25213276  }} </ref>
*When [[travel]]<ref name="urlTraveling with children: MedlinePlus Medical Encyclopedia">{{cite web |url=https://medlineplus.gov/ency/article/002427.htm |title=Traveling with children: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
*When [[travel]]<ref name="urlTraveling with children: MedlinePlus Medical Encyclopedia">{{cite web |url=https://medlineplus.gov/ency/article/002427.htm |title=Traveling with children: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
Line 314: Line 299:
*Use [[pain relievers]] such as [[acetaminophen]] or [[ibuprofen]].<ref name="urlEarache: MedlinePlus Medical Encyclopedia">{{cite web |url=https://medlineplus.gov/ency/article/003046.htm |title=Earache: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
*Use [[pain relievers]] such as [[acetaminophen]] or [[ibuprofen]].<ref name="urlEarache: MedlinePlus Medical Encyclopedia">{{cite web |url=https://medlineplus.gov/ency/article/003046.htm |title=Earache: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
*The upright position can reduce pressure in the middle ear. <ref name="urlEarache: MedlinePlus Medical Encyclopedia">{{cite web |url=https://medlineplus.gov/ency/article/003046.htm |title=Earache: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
*The upright position can reduce pressure in the middle ear. <ref name="urlEarache: MedlinePlus Medical Encyclopedia">{{cite web |url=https://medlineplus.gov/ency/article/003046.htm |title=Earache: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
*tonsilitis.<ref name="urlTonsillitis | Tonsillitis Symptoms | Tonsillitis Treatment | MedlinePlus">{{cite web |url=https://medlineplus.gov/tonsillitis.html |title=Tonsillitis &#124; Tonsillitis Symptoms &#124; Tonsillitis Treatment &#124; MedlinePlus |format= |work= |accessdate=}}</ref>
**Drink more water.
**If there is pain during swallowing, eat smooth foods like soups.
***Wash your hands.
***Gargles with saltwater.
***Stay away from things that cause irritation in the throat like smoke.


==Don'ts==
==Don'ts==


*Do not use [[antibiotics]] unless necessary because widespread use can lead to resistent.<ref name="pmid24453496">{{cite journal| author=Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M| title=Update on otitis media - prevention and treatment. | journal=Infect Drug Resist | year= 2014 | volume= 7 | issue=  | pages= 15-24 | pmid=24453496 | doi=10.2147/IDR.S39637 | pmc=3894142 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24453496  }} </ref>
*Do not use [[antibiotics]] unless necessary because widespread use can lead to resistent.<ref name="pmid24453496">{{cite journal| author=Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M| title=Update on otitis media - prevention and treatment. | journal=Infect Drug Resist | year= 2014 | volume= 7 | issue=  | pages= 15-24 | pmid=24453496 | doi=10.2147/IDR.S39637 | pmc=3894142 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24453496  }} </ref>
*Do not let child sleep during takeoff or landing because when he awake he can swallow more.<ref name="urlTraveling with children: MedlinePlus Medical Encyclopedia">{{cite web |url=https://medlineplus.gov/ency/article/002427.htm |title=Traveling with children: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
*Do not let child sleep during takeoff or landing because when he awakes he can swallow more.<ref name="urlTraveling with children: MedlinePlus Medical Encyclopedia">{{cite web |url=https://medlineplus.gov/ency/article/002427.htm |title=Traveling with children: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
*Don not use [[aspirin]].<ref name="urlEarache: MedlinePlus Medical Encyclopedia">{{cite web |url=https://medlineplus.gov/ency/article/003046.htm |title=Earache: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
*Don not use [[aspirin]].<ref name="urlEarache: MedlinePlus Medical Encyclopedia">{{cite web |url=https://medlineplus.gov/ency/article/003046.htm |title=Earache: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
*Do not smocking near the children because it increase the [[ear infection]].<ref name="urlEarache: MedlinePlus Medical Encyclopedia">{{cite web |url=https://medlineplus.gov/ency/article/003046.htm |title=Earache: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
*Do not smocking near the children because it incresase the [[ear infection]].<ref name="urlEarache: MedlinePlus Medical Encyclopedia">{{cite web |url=https://medlineplus.gov/ency/article/003046.htm |title=Earache: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
   
   
   
   
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[[Category:Resident survival guide]]
[[Category:Resident survival guide]]
[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Primary care]]

Latest revision as of 21:49, 1 March 2021



Resident
Survival
Guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Amira Albawri

Synonyms and keywords: Ear pain , otalgia , ear sore , otitis , ear infection , ear discomfort and ear aches.

Ear pain resident survival guide (pediatrics) Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Overview

Ear pain is the most common cause that affects children. Mortality rates are generally low, but acute otitis media and otitis media with effusion have high morbidity. the child can come with fever, restless sleep, ear rubbing, irritability, excessive crying, decreased activity, poor appetite, rhinitis, nasal congestion, cough, hoarse voice, conjunctivitis, mucus vomiting.There are several causes divided into primary otalgia and secondary otologia .The primary otalogia including otitis externa (swimmer's ear), mechanical obstruction ,Otitis media ,otitis media with effusion, truma .The secondary otalgia including referred ear pain.

Causes

Common Causes

Primary otalgia

The following are the causes of primary otalgia:[1][2]

Otitis externa (swimmer's ear)

Mechanical obstruction

Otitis media[8][9][10]

Otitis media with effusion[13][10][14]

Truma

Secondary otalgia

Referred ear pain

Classification of otitis media

FIRE: Focused Initial Rapid Evaluation

Parents are considered as the most reliable proxy for assessing ear pain at young children[18] . If child come with restless sleep, ear rubbing, irritability, excessive crying, decreased activity, poor appetite and may be with fever we should think about ear pain .the help us to know the cause of ear pain is examination by otoscopy reveals the tympanic membrane if its bulging, retraction,fluid behind the eardrum o itf there is foreign body[19].

Ear pain[20]

  • Normal tympanic membrane examination(otoscopy).
    • secondary otalgia.
  • Imaging studies.

The IF Diagnosis is not clear from the history and physical examination.

Complete Diagnostic Approach

Treatment

Table

Key differences in the 2004 and 2013 American Academy of Pediatrics guidelines for the diagnosis and management of acute otitis media (AOM)[17]

 
 
 
 
 
 
 
 
 
 
 
 
Characterize the pain
  • Usually the parents use pain scales to detect pain in their young children .[19]
  • Ear-related symptoms: ear rubbing.
  • Non-specific symptoms: fever, irritability, excessive crying, decreased activity, poor appetite, and restless sleep.
  • Respiratory symptoms: rhinitis, cough, hoarse voice, conjunctivitis, mucus vomiting, and nasal congestion.
  • Gastrointestinal symptoms: vomiting, and diarrhea.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
History
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Examination

It does not do for children who have been diagnosed on the basis of assessment in the clinic. [21] [10]

If the tympanic membrane is abnormal, the most likely cause of it by primary otalgia. The main causes of primary otalgia include

 
 
 
 
 
Subject 2004 2013 Rationale for 2013 Changes
Children <6 mo Treat with antibiotic therapy No recommendations

Diagnosis of AOM Acute onset of signs and symptoms Moderate to severe bulging of TM, or new-onset otorrhea not owing to acute otitis externa 2004 criteria allowed less precise diagnosis and provided treatment recommendation when diagnosis was uncertain.
Presence of MEE Mild bulging of TM and recent onset ear pain and intense TM erythema
Signs and symptoms of middle ear inflammationa Must have MEE

Uncertain diagnosis Expected and included in treatment guidelines Excluded Emphasized need for diagnosis of AOM for best management.

Initial observation option instead of the initial antibiotic therapy Option for observation:
  • 6 mo–2 y: Option if uncertain diagnosis or non-severe illness
  • ≥2 y: Option if nonsevered and certain diagnosis
Option for observation:
  • 6 mo–2 y: Unilateral OM without otorrhea
  • ≥2 y: Unilateral or bilateral AOM without otorrhea
Favorable natural history overall.
Observation recommended:
  • ≥2 y and uncertain diagnosis
Observation recommended:
  • None
Evidence of the small benefits of antibiotics in recent trials that used stringent diagnostic criteria.

Initial antibiotic therapy recommended Antibiotics recommended:
  • <6 mo: All cases
  • 6 mo–2 y: Certain diagnosis, or uncertain diagnosis if severe illness
  • ≥2 y: Certain diagnosis and severe illness
Antibiotics recommended:
  • 6 mo–2 y: Otorrhea or severe illness or bilateral without otorrhea
  • ≥2 y: Otorrhea or severe illness
More stringent diagnostic guidelines in 2013 should lead to greater antibiotic benefit.
Antibiotics an option:
  • 6 mo–2 y: Uncertain diagnosis and non-severed illness
  • ≥2 y: Certain diagnosis and nonsevered illness
Antibiotics an option:
  • 6 mo–2 y: Unilateral without otorrhea
  • ≥2 y: Bilateral without otorrhea or unilateral without otorrhea
Greater antibiotic benefit for bilateral disease, AOM with otorrhea.
Two recent studies show small benefit of antibiotics for age 6–24 mo.

Recurrent AOM No recommendations Do not prescribe prophylactic antibiotics Minimal benefit for prophylaxis and antibiotics come with risks (antibiotic resistance and adverse effects).
May offer tympanostomy tubes Modest reduction in AOM with tubes.

Abbreviations: MEE, middle ear effusion; TM, tympanic membrane.

Signs and symptoms of middle ear inflammation include distinct erythema of TM or distinct otalgia (‘discomfort clearly referable to the ear's) that results in interference with or precludes normal activity or sleep’).

bRecent: <48 hours.

Ear pain may be indicated by holding, tugging, or rubbing of the ear in a nonverbal child.

non-severe illness was defined as mild otalgia and fever <39°C in the past 24 hours in the 2004 guideline; the 2013 guideline modifies this to “mild otalgia for less than 48 hours and a temperature of less than 39°C.”

Severe signs or symptoms include moderate or severe otalgia or temperature ≥39°C in 2004 guidelines; the 2013 guideline also includes otalgia for ≥48 hours.

Adapted from Lieberthal AS, Carroll AE, Chonmaitree T, et al. diagnosis and management of acute otitis media. Pediatrics 2013;131(3):e964–99; and American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics 2004;113(5):1451–65


 
 
 
 
Treat the underlying causes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fatigue due to Acut otitis media

❑In general,approximately 80% of children have spontaneous relief AOM within 2–14 days who absence of suspected complications follows initial treatment of symptomatic (analgesia and antipyretics) as fever and ear pain.If severe,recurrent infections or persistent give antibioticor if there is complication may offer tympanostomy tubes.[10]
❑If we use analgisic[17]Oral acetaminophen and ibuprofen are commonly used to treat pain in children.[26]
❑ If we use antibiotics.[17]

 
Fatigue due toAcute otitis externa[23]

❑American guidelines promote initial ototopical therapy without systemic antibiotics for uncomplicated acute otitis externa such as topical antibiotics with or without topical corticosteroids.

❑Oral antibiotics use for infection have spread beyond the ear canal.
 
Fatigue due to Otitis media with effusion.

❑Antibiotics, histamines or decongestants not effect at treatment[27] ❑In less sever case and without hearing problems, the effusion can resolve spontaneously or with autoinflation [28]

❑In sever case or persistent symptomatic cases, the treatment is by tympanostomy with or without adenoidectomy.[29][30]
 
Fatigue due to Tonsilitis

❑Treatment depends on the cause.
❑IF the cause is viral it is go by alone.[31] ❑Antibiotics.

  • If the cause is group A streptococcus, the first-line therapy antibiotics are used is penicillin or amoxicillin[32][33] .If there is alergic to pinicillin we can use a macrolide [34].If there is no response to penicillin therapy, we can use clindamycin or amoxicillin-clavulanate[35] .

❑Pain medication. ❑Surgery.

  • Tonsillectomy[36] . It is as a choice for treatment the chronic tonsillitis
 
Fatigue due to Ear wax

❑First-line treatmen is softening ear drops (oil or water).[37] [38]

❑Ear syringing.

Do's

Don'ts

  • Do not use antibiotics unless necessary because widespread use can lead to resistent.[10]
  • Do not let child sleep during takeoff or landing because when he awakes he can swallow more.[39]
  • Don not use aspirin.[41]
  • Do not smocking near the children because it incresase the ear infection.[41]


References

  1. 1.0 1.1 Neilan RE, Roland PS (2010). "Otalgia". Med Clin North Am. 94 (5): 961–71. doi:10.1016/j.mcna.2010.05.004. PMID 20736106.
  2. 2.0 2.1 Earwood JS, Rogers TS, Rathjen NA (2018). "Ear Pain: Diagnosing Common and Uncommon Causes". Am Fam Physician. 97 (1): 20–27. PMID 29365233.
  3. Zichichi L, Asta G, Noto G (2000). "Pseudomonas aeruginosa folliculitis after shower/bath exposure". Int J Dermatol. 39 (4): 270–3. doi:10.1046/j.1365-4362.2000.00931.x. PMID 10809975.
  4. Wang MC, Liu CY, Shiao AS, Wang T (2005). "Ear problems in swimmers". J Chin Med Assoc. 68 (8): 347–52. doi:10.1016/S1726-4901(09)70174-1. PMID 16138712.
  5. Schaefer P, Baugh RF (2012). "Acute otitis externa: an update". Am Fam Physician. 86 (11): 1055–61. PMID 23198673.
  6. Schwartz SR, Magit AE, Rosenfeld RM, Ballachanda BB, Hackell JM, Krouse HJ; et al. (2017). "Clinical Practice Guideline (Update): Earwax (Cerumen Impaction) Executive Summary". Otolaryngol Head Neck Surg. 156 (1): 14–29. doi:10.1177/0194599816678832. PMID 28045632.
  7. Conover K (2013). "Earache". Emerg Med Clin North Am. 31 (2): 413–42. doi:10.1016/j.emc.2013.02.001. PMID 23601480.
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  10. 10.0 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 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.
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  15. Wright T (2015). "Middle-ear pain and trauma during air travel". BMJ Clin Evid. 2015. PMC 4298289. PMID 25599243.
  16. Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA; et al. (2019). "Clinical Practice Guideline: Tonsillectomy in Children (Update)". Otolaryngol Head Neck Surg. 160 (1_suppl): S1–S42. doi:10.1177/0194599818801757. PMID 30798778.
  17. 17.0 17.1 17.2 17.3 17.4 Rettig E, Tunkel DE (2014). "Contemporary concepts in management of acute otitis media in children". Otolaryngol Clin North Am. 47 (5): 651–72. doi:10.1016/j.otc.2014.06.006. PMC 4393005. PMID 25213276.
  18. American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health. Task Force on Pain in Infants, Children, and Adolescents (2001). "The assessment and management of acute pain in infants, children, and adolescents". Pediatrics. 108 (3): 793–7. doi:10.1542/peds.108.3.793. PMID 11533354.
  19. 19.0 19.1 Uitti JM, Salanterä S, Laine MK, Tähtinen PA, Ruohola A (2018). "Adaptation of pain scales for parent observation: are pain scales and symptoms useful in detecting pain of young children with the suspicion of acute otitis media?". BMC Pediatr. 18 (1): 392. doi:10.1186/s12887-018-1361-y. PMC 6302518. PMID 30572868.
  20. Ely JW, Hansen MR, Clark EC (2008). "Diagnosis of ear pain". Am Fam Physician. 77 (5): 621–8. PMID 18350760.
  21. Rovers MM, Schilder AG, Zielhuis GA, Rosenfeld RM (2004). "Otitis media". Lancet. 363 (9407): 465–73. doi:10.1016/S0140-6736(04)15495-0. PMID 14962529.
  22. Schilder AG, Chonmaitree T, Cripps AW, Rosenfeld RM, Casselbrant ML, Haggard MP; et al. (2016). "Otitis media". Nat Rev Dis Primers. 2: 16063. doi:10.1038/nrdp.2016.63. PMC 7097351 Check |pmc= value (help). PMID 27604644.
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  24. Browning GG (2008). "Ear wax". BMJ Clin Evid. 2008. PMC 2907972. PMID 19450340.
  25. Michaudet C, Malaty J (2018). "Cerumen Impaction: Diagnosis and Management". Am Fam Physician. 98 (8): 525–529. PMID 30277727.
  26. Bertin L, Pons G, d'Athis P, Duhamel JF, Maudelonde C, Lasfargues G; et al. (1996). "A randomized, double-blind, multicentre trial of ibuprofen versus acetaminophen and placebo for symptoms of acute otitis media in children". Fundam Clin Pharmacol. 10 (4): 387–92. doi:10.1111/j.1472-8206.1996.tb00590.x. PMID 8871138.
  27. Griffin G, Flynn CA (2011). "Antihistamines and/or decongestants for otitis media with effusion (OME) in children". Cochrane Database Syst Rev (9): CD003423. doi:10.1002/14651858.CD003423.pub3. PMC 7170417 Check |pmc= value (help). PMID 21901683.
  28. Blanshard JD, Maw AR, Bawden R (1993). "Conservative treatment of otitis media with effusion by autoinflation of the middle ear". Clin Otolaryngol Allied Sci. 18 (3): 188–92. doi:10.1111/j.1365-2273.1993.tb00827.x. PMID 8365006.
  29. Browning GG, Rovers MM, Williamson I, Lous J, Burton MJ (2010). "Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children". Cochrane Database Syst Rev (10): CD001801. doi:10.1002/14651858.CD001801.pub3. PMID 20927726.
  30. Atkinson H, Wallis S, Coatesworth AP (2015). "Otitis media with effusion". Postgrad Med. 127 (4): 381–5. doi:10.1080/00325481.2015.1028317. PMID 25913597.
  31. 31.0 31.1 [+https://medlineplus.gov/tonsillitis.html "Tonsillitis | Tonsillitis Symptoms | Tonsillitis Treatment | MedlinePlus"] Check |url= value (help).
  32. Bird JH, Biggs TC, King EV (2014). "Controversies in the review of acute tonsillitis: an evidence-based review". Clin Otolaryngol. 39 (6): 368–74. doi:10.1111/coa.12299. PMC 7162355 Check |pmc= value (help). PMID 25418818.
  33. Touw-Otten FW, Johansen KS (1992). "Diagnosis, antibiotic treatment and outcome of acute tonsillitis: report of a WHO Regional Office for Europe study in 17 European countries". Fam Pract. 9 (3): 255–62. doi:10.1093/fampra/9.3.255. PMID 1459378.
  34. Casey JR, Pichichero ME (2004). "Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children". Pediatrics. 113 (4): 866–82. doi:10.1542/peds.113.4.866. PMID 15060239.
  35. Brook I (2009). "The role of beta-lactamase-producing-bacteria in mixed infections". BMC Infect Dis. 9: 202. doi:10.1186/1471-2334-9-202. PMC 2804585. PMID 20003454.
  36. Burton MJ, Glasziou PP, Chong LY, Venekamp RP (2014). "Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis". Cochrane Database Syst Rev (11): CD001802. doi:10.1002/14651858.CD001802.pub3. PMC 7075105 Check |pmc= value (help). PMID 25407135. Review in: Evid Based Med. 2015 Apr;20(2):64
  37. Aaron K, Cooper TE, Warner L, Burton MJ (2018). "Ear drops for the removal of ear wax". Cochrane Database Syst Rev. 7: CD012171. doi:10.1002/14651858.CD012171.pub2. PMC 6492540. PMID 30043448.
  38. Poulton S, Yau S, Anderson D, Bennett D (2015). "Ear wax management". Aust Fam Physician. 44 (10): 731–4. PMID 26484488.
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  40. "Swimmer's Ear (External Otitis) (for Teens) - Nemours KidsHealth".
  41. 41.0 41.1 41.2 41.3 41.4 "Earache: MedlinePlus Medical Encyclopedia".