Guideline 66: Diagnosis and management of childhood otitis media in primary care

Diagnosis and management of childhood otitis media in primary care
Section 1: Introduction

1.1 The need for a guideline

In terms of morbidity in children managed in general practice, middle ear conditions are probably the most important relating to the upper respiratory tract, with 75% of all cases of acute otitis media (AOM) occurring in children under the age of 10 years. One in four children will have an episode of AOM at some time during the first 10 years of life with a peak incidence of diagnosis occurring between the ages of three and six years.¹ North American studies have suggested that the incidence is higher in children in the first two years of life.^{2,
3, 4,
5} The prevalence of otitis media with effusion (OME), commonly referred to as glue ear, is very high. In one study, around 80% of children had OME at least once before the age of four.⁶

1.2 Remit of the guideline

This guideline provides recommendations based on current evidence for best practice in the management of acute otitis media and otitis media with effusion. It provides evidence about detection, management, referral and follow up of children with these conditions.

It excludes discussion of surgical management such as the insertion of grommets and does not address issues beyond childhood years. In addition, the needs of children with genetic or facial abnormalities are not considered.

This guideline is likely to be of interest to general practitioners (GPs), practice nurses, audiologists, paediatricians, otolaryngologists, audiological physicians, health visitors, social workers, public health physicians, users of services and all other professions caring for children.

1.3 Statement of intent

This guideline is not intended to be construed or to serve as a standard of medical care. Standards of care are determined on the basis of all clinical data available for an individual case and are subject to change as scientific knowledge and technology advance and patterns of care evolve. These parameters of practice should be considered guidelines only. Adherence to them will not ensure a successful outcome in every case, nor should they be construed as including all proper methods of care or excluding other acceptable methods of care aimed at the same results. The ultimate judgement regarding a particular clinical procedure or treatment plan must be made by the doctor, following discussion of the options with the patient, in light of the diagnostic and treatment choices available. However, it is advised, that significant departures from the national guideline or any local guidelines derived from it should be fully documented in the patient’s case notes at the time the relevant decision is taken.

1.4 Review and updating

This guideline was issued in 2003 and will be considered for review as new evidence becomes available. Any updates to the guideline in the interim period will be noted on the SIGN website: www.sign.ac.uk