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A 15-month-old boy is brought by both parents to his family physician with a 2-day history of fever, irritability, and frequent tugging of his left ear. This was preceded by a 1-week history of nasal congestion, cough, and rhinorrhea. On otoscopy, his left tympanic membrane (TM) appears erythematous, cloudy, bulging, and exudative (Figure 26-1). His left TM fails to move on pneumatic otoscopy. The physician diagnoses acute otitis media and decides with the parents to prescribe a 10-day course of amoxicillin; the child recovers uneventfully.
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In follow-up 2 months later, the child appears healthy and is meeting all his developmental milestones. On otoscopic examination, air-fluid levels are seen in the right ear (Figure 26-2). The physician explains the diagnosis of otitis media with effusion to the parents and arranges follow-up. Three months later the effusion is completely resolved.
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Acute otitis media (AOM) is the most common diagnosis for acute office visits for children.1 AOM is characterized by middle-ear effusion in a patient with signs and symptoms of acute illness (e.g., fever, irritability, otalgia). Otitis media with effusion (OME) is a disorder characterized by fluid in the middle ear in a patient without signs and symptoms of acute ear infection; it is also very common in childhood.
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- AOM accounted for $5 billion of the total national health expenditure in 2000; more than 40% was incurred for children between 1 and 3 years of age.1
- It is estimated that 60% to 80% of children in the United States develop AOM by 1 year of age and that 80% to 90% develop AOM by 2 to 3 years of age.2,3
- The highest incidence occurs between 6 and 24 months of age.2,3
- AOM is the most common reason for outpatient antibiotic treatment in the United States.4 A national survey in 1992 revealed that 30% of all antibiotics prescribed for children younger than age 18 years was for treatment of AOM.5
- OME is diagnosed in 2.2 million children yearly in the United States.6
- Approximately 90% of children (80% of individual ears) have OME at some time before school age, most often between ages 6 months and 4 years.6
- The combined direct and indirect health care costs of OME amount to $4 billion annually.6
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AOM is often preceded by upper respiratory ...