Recurrent Otitis media (Paediatric)

Acute episode treat as Acute Otitis Media (Tayside formulary)

Recurrent Acute Otitis Media (AOM)

Ear infections are very common and in the absence of complications we wouldn’t routinely see patients unless there have been

• Three or more separate episodes of AOM in the previous 6 months, or
• Four or more episodes in the previous 12 months.

Primary care

• Manage acute episodes in the same way as foracute otitis media (link above)
• In children with grommets who present with acute discharge:
  • Take an ear swab for culture and sensitivity.
  • Treat as AOM, additionally a course of cilodex ear drops 4 drops BD for 7 days can be given
• Provide advice on measures to prevent recurrence of AOM:
  • Avoiding exposure to passive smoking, use of dummies, supine feeding, ensuring they have had a complete course of pneumococcal vaccinations as part of the routine childhood immunization schedule, and that any GORD is managed appropriately.
• A prolonged course of low dose antibiotics may be considered (on advice from ENT).

• ENT
  • If recurrent AOM on a background of persistent underlying OME
  • Complications of AOM (mastoiditis, meningitis)
  • If the child has a craniofacial abnormality (Down's syndrome or a cleft palate) and is not already under surveillance with ENT +/- audiology +/- paediatrics.
• Paediatrics
  • If the patient has no evidence of OME or other otological concerns as above.

Currently being created

• NICE CKS. Otitis media - acute. Last revised August 2024.
• Venekamp RP, Javed F, van Dongen TM, Waddell A, Schilder AG. Interventions for children with ear discharge occurring at least two weeks following grommet (ventilation tube) insertion. Cochrane Database Syst Rev. 2016 Nov 17;11(11):CD011684. doi: 10.1002/14651858.CD011684.pub2. PMID: 27854381; PMCID: PMC6465056. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6465056/