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New Guidelines for Management of Otitis Media



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Am Fam Physician. 2004 Jun 15;69(12):2741.

This issue covers new guidelines on the diagnosis and management of otitis media with effusion (OME) released by the Subcommittee on Otitis Media with Effusion, which was convened by the American Academy of Pediatrics (AAP), the American Academy of Family Physicians, and the American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS). A summary of the recommendations appears in “Practice Guidelines” on page 2929, and the complete guidelines are available online at http://www.aafp.org/x1596.xml.

An accompanying editorial written by members of the Subcommittee on Otitis Media with Effusion appears on page 2776. Richard M. Rosenfeld, M.D., M.P.H., Larry Culpepper, M.D., M.P.H., Barbara Yawn, M.D., M.Sc., and Martin C. Mahoney, M.D., Ph.D., representing the committee, note that the recommendations are an update of a clinical practice guideline originally released in 1994 by the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality). The updated guidelines provide clinicians with evidence-based methods to identify, monitor, and manage OME in children two months through 12 years of age with or without developmental disabilities or underlying conditions that predispose to OME. The original guideline was limited to children one year to three years of age with no craniofacial or neurologic abnormalities or sensory deficits.

The recommendations in the guideline are based on the best available published data, primarily the AHRQ report on OME from the Southern California Evidence-Based Practice Center (EPC), through April 2003. Consistent with the previous guideline, the new recommendations call for accurate diagnosis of OME, since differentiating OME from acute otitis media without effusion will avoid unnecessary antibiotic use. However, the updated guideline provides new recommendations regarding risk stratification, management, and monitoring, with regard to children who may be at risk for speech, language, or learning problems.

Also included in this issue is a “Point-of-Care Guide” that provides a patient encounter form for use with children two months to 12 years of age who present with earache. The form includes an assessment of pain, the definition of AOM, clinical decision support for the use of an antibiotic, guidance on selection of the most appropriate antibiotic, and a reminder to recommend analgesia. This form, developed by Mark H. Ebell, M.D., M.D., AFP’s deputy editor for evidence-based medicine, is based on the AAP, AAFP, AAO-HNS guidelines. The guidelines are available to physicians to photocopy and use in their practices. The form is also available online at http://www.aafp.org/afp/2004/0615/p2896.html.


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