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Quiz: Do You Know How Best to Approach Otitis Media?

Russell W. Steele, MD

March 23, 2015

Otitis media is the second most common disease of childhood, after upper respiratory infection. It is also the most common cause of childhood visits to a physician's office. Annually, nearly 20 million office visits are attributed to otitis media. Do you know how best to approach this incredibly common condition? Test your knowledge with this short quiz.

Which of the following bacterial pathogens most commonly causes recurrent otitis media?

Moraxella catarrhalis

Streptococcus pneumoniae

Nontypeable Haemophilus influenzae

Staphylococcus aureus

The most common bacterial pathogens in acute otitis media are S pneumoniae, nontypeable H influenzae, and M catarrhalis. These three organisms are responsible for more than 95% of all acute otitis media cases with a bacterial etiology. Older studies indicated that S pneumoniae was more common; however, with the introduction of pneumococcal vaccines, nontypeable H influenzae now appears to be the most prevalent pathogen.

Of these three organisms causing acute otitis media, S pneumoniae is the least likely to resolve spontaneously. Attention is therefore focused on S pneumoniae for selection of antimicrobial therapy.

For more on the etiology of otitis media, read here.

Which of the following age groups represents the peak prevalence for otitis media?

Birth to 5 months

6-18 months

1-3 years

2-5 years

Peak prevalence of otitis media in both sexes occurs in children aged 6-18 months; this is attributable to the more horizontal anatomy of the eustachian tube at this age. Some studies show bimodal prevalence peaks; a second, lower peak occurs at age 4-5 years and corresponds with school entry.

Although otitis media can occur at any age, 80%-90% of cases occur in children younger than 6 years. Children who are diagnosed with acute otitis media during the first year of life are much more likely to develop recurrent otitis media and chronic otitis media with effusion than children in whom the first middle ear infection occurs after age 1 year.

For more on the epidemiology of otitis media, read here.

Which of the following studies is the standard examination technique for patients with suspected otitis media?

Tympanometry

Acoustic reflectometry

Audiometry

Pneumatic otoscopy

Pneumatic otoscopy remains the standard examination technique for patients with suspected otitis media. When performed correctly, it is 90% sensitive and 80% specific for diagnosis of acute otitis media, and its findings are more accurate than those of myringotomy. However, accuracy of this examination takes experience; estimates suggest that a pediatrician needs approximately 5 years in practice before such accuracy is achieved. Tympanometry, acoustic reflectometry, and audiometry are important adjunctive techniques with which to evaluate patients with middle ear effusion.

For more on the use of pneumatic otoscopy for otitis media, read here.

According to the February 2013 guidelines from the American Academy of Pediatrics and the American Academy of Family Practice, which of the following is the antibiotic of choice in treating acute otitis media?

Cefaclor

Azithromycin

Trimethoprim/sulfamethoxazole

Amoxicillin

The 2013 guidelines for the medical management of acute otitis media indicate that amoxicillin is the antibiotic of choice unless the child has received it within 30 days, has concurrent purulent conjunctivitis, or is allergic to penicillin; in these cases, clinicians should prescribe an antibiotic with additional beta-lactamase coverage. Many experts recommend high-dose amoxicillin (80-90 mg/kg/d) if the child has received amoxicillin during the previous 90 days or lives in an area with a high prevalence of intermediately resistant pneumococcus.

For more about the treatment of otitis media, read here.

Which of the following is not an accepted risk factor for acute otitis media in children younger than 4 years?

Day care attendance

Exposure to tobacco smoke

Allergies

Pacifier use

The relation between allergies and otitis media remains unclear. In children younger than 4 years, the immune system is still developing, and allergies are unlikely to play a role in recurrent acute otitis media in this age group. Recognized risk factors include day care attendance, secondary exposure to tobacco smoke, pacifier use, bottle propping, and breastfeeding for less than 3 months (breastfeeding for 3 months or longer decreases risk).

For more on the risk factors for acute otitis media, read here.

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Cite this article: Russell W. Steele. Quiz: Do You Know How Best to Approach Otitis Media? Medscape. Mar 23, 2015.

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