Current treatment of otitis media in children.

Otitis media is a common childhood disease with a spectrum of pathology ranging from acute, painful infection to persistent middle ear effusion to chronic negative middle ear pressure and development of cholesteatoma. Amoxicillin remains the initial empiric drug of choice with TMP-SMZ or erythromycin-sulfisoxazole used for penicillinallergic patients or for amoxicillin therapy failures. Amoxicillin-clavulante, cefuroxime axetil (no elixir form available) or cefixime may then be tried keeping in mind relative costs, side effects, dosing frequency and drug formulation. Prophylactic amoxicillin or sulfisoxazole at one-half the usual daily dose given once a day throughout the URI season is effective in reducing the number of episodes of AOME. Prolonged sulfonamide use should be carefully monitored. Tympanostomy tube insertion is indicated for frequently recurring otitis media and for persistent middle ear effusions. Adenoidectomy is an adjunctive procedure shown to be effective in children requiring a second set of tubes for recurrent infections or for children four years old or older with persistent middle ear fluid. Tympanoplasty may be necessary to prevent ossicular chain damage due to severe cases of MEVD or to repair non-healing perforations. Cholesteatomas must be surgically removed and may require elaborate reconstructive techniques.