Case Study: Diagnosis, Treatment and Management of Acute Otitis Media

This case study focuses on an 8-year-old male patient presenting with acute otitis media (AOM). The patient's history includes mild upper respiratory symptoms that progressed to fever and right ear pain. The diagnosis is made through clinical examination, including otoscopy and assessment of the tympanic membrane. The treatment plan includes antibiotic therapy, with amoxicillin as the drug of choice, along with analgesics and antipyretics for symptom management. The case study also explores alternative therapies and monitoring parameters. Patient education regarding the disease, its causes, and importance of vaccinations is emphasized. The study concludes by highlighting the importance of watchful waiting and the potential adverse effects of antibiotic use. References to relevant guidelines and research papers are included to support the analysis. This case study provides a comprehensive overview of AOM, covering diagnosis, treatment, and patient management strategies.

Running Head: ACUTE OTITIS MEDIA
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Name of the Student
Name of the University
Author’s Note

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Introduction
This case study is about a patient who is 8 years old and suffers from slight upper
respiratory disturbances that began 5 days ago. The symptoms were mild sore throat,
nonproductive cough and sneezing. Gradually he started suffering from fever and then
complained of right ear pain (Venekamp, Damoiseaux and Schilder 2014). The child has healthy
all these years without the susceptibility of any chronic disease and he was not prescribed any
medicine except for an over the counter vitamin. Her mother notified that he missed his last
MMR vaccine before he was admitted to school because she was unable to remember. His vitals
were almost normal and his nasal turbinates were mild pink, nasal discharge was clear, pre-
auricular swelling of the lymph gland was identified on the right side. The tympanic membrane
of the right side was red, light reflex was absent and an immobile slight bulge was seen. All these
suggested that he was suffering from acute otitis media.
Diagnosis
The diagnosis of this disease is possible through several instruments that are used for
looking inside the ear. It can be diagnosed with the help of otoscope, which is used for looking
into the ears during checkups or investigating ear symptoms as it gives a clear view of the ear
drum and ear canal. Tympanometry is used for tests that detects the air pressure inside the child’s
ear to find if the ear drum is damaged. Reflectometry is a small instrument that creates sound
inside the ear of the child, which helps in determining fluid content inside the ear when the sound
reflects back from the ear. An ear test can be performed to find out if the child is not suffering
from hearing loss due to acute otitis media (Kitamura et al. 2015).

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Treatment Plan
The most common management for this infection is antibiotic therapy. Administration of
analgesics and antipyretics are also recommended for the treatment of acute otitis media. In the
initial stages, home care is recommended by applying warm and moist cloth around the infected
area, including over the counter drugs or ear drops for the pain and taking pain relievers such as
acetaminophen and ibuprofen. Children who are severely ill with a bulging tympanic membrane
and middle ear effusion should be medicated with antibiotics. Children with mild fever or illness
including mild or moderate bulging of the tympanic membrane and mild otalgia can be given
antipyretics. These medications should be provided only after a watchful waiting or when there
is no end to pain for 24-48 hours. Surgical procedures are also recommended in severe cases
(Sakulchit and Goldman, 2017).
Drugs of Choice
The most recommended antibiotic for the treatment of this disease is amoxicillin. The
dose given is 45 to 60 mg/kg per day divided between 3 doses. Amoxicillin-clavulanate is
considered when there is a conjunctivitis with concurrent purulent. If the child has allergies from
this medicine then second generation or third generation cephalosporin is prescribed for acute
otitis media. Sometimes when oral medication is not suitable then intravenous administration is
given with ceftriaxone. Amoxicillin acts on the bacterial growth during an ear infection, which is
found in acute otitis media. It prevents the growth and kills them from increasing the infection by
creating a cell wall (Marchisio et al. 2014). This antibiotic is similar to penicillin as it works
against susceptible bacteria when it is on the stage of active multiplication. The site of action is
the cell wall biosynthesis and it inhibitions all sources of production leading to bacterial death.
The half-life of this medicine is 61.3 minutes and around 60% of the orally administered dose is

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excreted through the urine in 6-8 hours. Amoxicillin is metabolized by the liver and the action
begins after 30 minutes of the consumption (Venekamp et al. 2015).
Complimentary Alternative Therapy or OTC Therapy
Complimentary alternative therapy is the replacement of medical treatment with
alternative treatment such as massage, drinking tea, acupuncture or tai chi. In the case of acute
otitis media, several alternatives can be applied such as acupuncture, which is used for balancing
the energy of the body and the external canals of the ear can be punctured for preventing acute
otitis media. More alternatives such as homeopathy, osteopathy, chiropratic, xylitol, ear candling
and vitamin D supplement. All these alternatives can be utilized before the intervention of
medical treatment. Probiotics can be recommended for preventing any infection, which can cause
acute otitis media (Marom et al. 2016).
Over the counter drugs can be given during pain and infection in acute otitis media such
as Tylenol and advil, which are pain killers used to decrease infection and inflammation. Tylenol
is also known acetaminophen, which is an analgesic and an antipyretic. It helps in reducing the
secretion of prostaglandin in the brain, which is the reason for swelling and inflammation. The
half-life is 2-3 hours and it is metabolized in the liver through hepatic pathways. Advil is a non-
steroidal anti-inflammatory drug that also works by inhibiting the production of substances that
causes inflammation. The half-life of this medicine is 2 hours and it is also metabolized in the
liver (Deniz et al. 2018).
Monitoring Parameters
The treatment of every health complication needs a follow up to make sure the treatment
is taking its course and it is effective. It is the same with acute otitis media, which makes the

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medical practitioners to make appointments for the patients who are going through this disease.
Children who are being observed need to have a follow up with their parents when there is no
improvement under 48-72 hours. If a visit is not possible then a phone contact or a safety net
antibiotic prescription can be made prior to the incident if the pain is not reduced within 48-72
hours. The parameters to check will be hearing capabilities, inspection of the ear canal and ear
drum and checking of the fluid inside the ears.
Patient Education
Patients need to be educated about the pathophysiology, diagnosis and treatment of this
diseases as it keeps occurring mostly in children. This makes it more necessary that the adults are
aware about the immediate interventions to be taken when someone has tendencies of pain due to
acute otitis media (Célind, Södermark and Hjalmarson, 2014). The mother should be taught
about the importance of remembering about vaccinations and medications necessary for a
healthy condition for her child. This disease is the infection of middle ear, which is near the ear
drum and it occurs when the Eustachian tubes are plugged, irritated or affected due to the fluid
collection in the middle ear. The adverse effects of this disease is hearing loss or the child’s
disability to learn because the ear is connected to the functions of the brain.
Conclusion
Acute otitis media is a common infectious disease that is prevalent in children. Antibiotic
therapy can be detrimental for bacterial resistance and can cause further infectious diseases. It is
always preferable to watchfully wait for the progress in the disease because the symptoms can
reduce with time including the pain. As it is an inflammation of the ear due to types of virus so

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the first mode of treatment is always antibiotic but the adverse effects should be noted before
implementing it.

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References
Célind, J., Södermark, L. and Hjalmarson, O., 2014. Adherence to treatment guidelines for acute
otitis media in children. The necessity of an effective strategy of guideline
implementation. International journal of pediatric otorhinolaryngology, 78(7), pp.1128-1132.
Deniz, Y., van Uum, R.T., de Hoog, M.L., Schilder, A.G., Damoiseaux, R.A. and Venekamp,
R.P., 2018. Impact of acute otitis media clinical practice guidelines on antibiotic and analgesic
prescriptions: a systematic review. Archives of disease in childhood, 103(6), pp.597-602.
Kitamura, K., Iino, Y., Kamide, Y., Kudo, F., Nakayama, T., Suzuki, K., Taiji, H., Takahashi,
H., Yamanaka, N. and Uno, Y., 2015. Clinical practice guidelines for the diagnosis and
management of acute otitis media (AOM) in children in Japan–2013 update. Auris Nasus
Larynx, 42(2), pp.99-106.
Marchisio, P., Tagliabue, M., Klersy, C., Mira, E., Pagella, F., Baggi, E., Fattizzo, M., Esposito,
S. and Principi, N., 2014. Patterns in acute otitis media drug prescriptions: a survey of Italian
pediatricians and otolaryngologists. Expert review of anti-infective therapy, 12(9), pp.1159-1163.
Marom, T., Marchisio, P., Tamir, S.O., Torretta, S., Gavriel, H. and Esposito, S., 2016.
Complementary and alternative medicine treatment options for otitis media: a systematic
review. Medicine, 95(6).
Sakulchit, T. and Goldman, R.D., 2017. Antibiotic therapy for children with acute otitis
media. Canadian Family Physician, 63(9), pp.685-687.
Venekamp, R.P., Damoiseaux, R.A. and Schilder, A.G., 2014. Acute otitis media in
children. BMJ clinical evidence, 2014.

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Venekamp, R.P., Sanders, S.L., Glasziou, P.P., Del Mar, C.B. and Rovers, M.M., 2015.
Antibiotics for acute otitis media in children. Cochrane database of systematic reviews, (6).