Treatment in countries like the Netherlands is initially watchful waiting, and if unresolved, antibiotics are warranted. In the United States, the mainstay of treatment for an established diagnosis of AOM is high-dose amoxicillin, and this has been found to be most effective in children under two years of age. This has led to the development of specific guidelines for the treatment of OM. Without proper treatment, suppurative fluid from the middle ear can extend to the adjacent anatomical locations and result in complications such as tympanic membrane (TM) perforation, mastoiditis, labyrinthitis, petrositis, meningitis, brain abscess, hearing loss, lateral and cavernous sinus thrombosis, and others. Treatment of otitis media with antibiotics is controversial and directly related to the subtype of otitis media in question. Pneumatic otoscopy is the most reliable and has a higher sensitivity and specificity as compared to plain otoscopy, though tympanometry and other modalities can facilitate diagnosis if pneumatic otoscopy is unavailable. Several diagnostic tools are available such as a pneumatic otoscope, tympanometry, and acoustic reflectometry, to aid in the diagnosis of otitis media. Otitis media is diagnosed clinically via objective findings on physical exam (otoscopy) combined with the patient's history and presenting signs and symptoms. The most common viral pathogens of otitis media include the respiratory syncytial virus (RSV), coronaviruses, influenza viruses, adenoviruses, human metapneumovirus, and picornaviruses. Following the introduction of the conjugate pneumococcal vaccines, the pneumococcal organisms have evolved to non-vaccine serotypes. The most common bacterial organisms causing otitis media are Streptococcus pneumoniae, followed by non-typeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis. Infection of the middle ear can be viral, bacterial, or coinfection. Although otitis media can occur at any age, it is most commonly seen between the ages of 6 to 24 months. Acute otitis media is the second most common pediatric diagnosis in the emergency department, following upper respiratory infections. It is a spectrum of diseases that includes acute otitis media (AOM), chronic suppurative otitis media (CSOM), and otitis media with effusion (OME). Acute otitis media is defined as an infection of the middle ear space.
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