URTI CPG Booklet_consensus (English - pdf - 762 Kb) - MSO-HNS

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Figure 7 - Normal tympanic membraneFigure 8 - Otitis media effusionIt is highly important to exclude AOM in a febrile and irritable infant by earexamination.Clinicians should discriminate between Otitis Media with Effusion (OME) and AcuteOtitis Media (AOM) 34, Level II-2 . AOM is considered distinct from otitis media witheffusion (OME), which is defined as the presence of fluid in the middle ear withoutsigns or symptoms of acute ear infection 26, Level I . When OME is mistakenly diagnosedas AOM, antibacterial agents may be prescribed unnecessarily 30, Level I; 38, Level III .WHEN TO REFER TO ENT SPECIALIST?1. Recurrent acute otitis media2. Persistent otorrhea3. Concerns about mastoiditis or other complications of AOM4. Perceived need for tympanocyntesis and/or myringotomy5. Abnormal audiological evaluation3.3 COMPLICATIONSAOM may have potentially serious complications including mastoiditis, meningitis,and intracranial abscess formation.3.4 MANAGEMENTa. Assessment of painIf pain is present, the clinician should recommend treatment to reduce pain 27, Level I .Pain relief in the first 24 hours should be achieved with ibuprofen or acetaminophen,because antibiotics typically do not relieve pain in the first 24 hours, and they have onlya minimal effect on pain subsequently. By 24 hours, about 60% of children have painrelief, and this percentage increases to 80% to 90% within a few days 32, Level II-2 ; 28, Level I .13
. Observation without use of antibacterial agentsObservation without use of antibacterial agents (for 48 to 72 hours and limitingmanagement to symptomatic relief) in a child with uncomplicated AOM is anoption for selected children based on diagnostic certainty, age, illness severity, andassurance of follow-up 27, Level I .Criteria for Initial Antibacterial Agent Treatment or Observation in ChildrenWith AOMAge Diagnosis of AOM is uncertain Diagnosis of AOM is certain
Page 2 and 3: This guideline is meant to be a gui
Page 4 and 5: The draft guideline was posted on t
Page 6 and 7: REVIEW COMMITTEESThe process of dev
Page 8 and 9: 1.0 RHINOSINUSITISKEY POINTS1. Accu
Page 10 and 11: 1.4 INVESTIGATIONS• When the diag
Page 12 and 13: Management AlgorithmInitial evaluat
Page 14 and 15: 2.2 CLINICAL FEATURES2.2.1 The etio
Page 16 and 17: Strep Score for Group a Beta-Hemoly
Page 18 and 19: Management AlgorithmStrepScore=3Sym
Page 22 and 23: Once the patient has shown clinical
Page 24 and 25: Management AlgorithmChild aged 2 mo
Page 26 and 27: 13. Scheid DC, Hamm RM. (2004) Acut
Page 28 and 29: 37. Schappert SM. Office visits for
Page 30 and 31: 23NOTES
Page 32: Supported by an educational grant f

URTI CPG Booklet_consensus (English - pdf - 762 Kb) - MSO-HNS

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