Otitis Media Decision Tool



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acute otitis media tool[html]
Summary:  This decision tool applies the American Academy of Pediatrics Guideline Subcommittee on Management of Acute Otitis Media (2004) Pediatrics 113: 1451-65 for diagnosing and managing acute otitis media.
A similar paper-based encounter tool is available at Ebell (2004) Am Fam Physician 69: 2896-98 .[/html]
[select name="Q1" value="Age 2 to 6 months.=100|Age 6 months to 2 years.=1000|Age over 2 years.=10000"] <-- 1. Age group?
[select name="Q2" value="Initial visit for otitis.=0|Otitis follow up after observation.=20|Otitis follow up after antibiotic treatment.=40"] <-- 2. Visit timing?
[select name="Q3" value="No penicillin allergy.=0|Penicillin allergy present.=10"] <-- 3. Penicillin allergy?[html]
AAFP information on drug allergy Reidl (2003) Am Fam Physician 68: 1781-91[/html]
[select name="Q4" value="Onset not acute.=0|Onset acute.=1"] <-- 4. Acute onset? (Acute onset: Recent, usually abrupt onset of signs and symptoms of middle-ear inflammation and effusion.)[html]
American Academy of Pediatrics Slidebook of otoscope images
Middle ear effusion signs.[/html]
[select name="Q5" value="No bulging tympanic membrane.|One or both tympanic membranes bulging."] <-- 5. Bulging of the tympanic membrane?
[select name="Q6" value="Normal mobility of both tympanic membranes.|Limited or absent mobility of one or both tympanic membranes."] <-- 6. Limited or absent mobility of the tympanic membrane?
[select name="Q7" value="No otorrhea present.|Otorrhea at one or both ears."] <-- 7. Otorrhea?
[select name="Q8" value="No air fluid level seen.|Air fluid level seen at one or both tympanic membranes."] <-- 8. Air fluid level?[html]
Middle ear inflammation signs.[/html]
[select name="Q9" value="No distinct erythema at either tympanic membrane.|Distinct erythema at one or both tympanic membranes."] <-- 9. Distinct erythema at tympanic membrane?
[select name="Qten" value="Distinct oltalgia is not present.|Otalgia present that interferes with or precludes normal activity or sleep."] <-- 10. Significant otalgia? [comment memo="Symptom of middle ear inflammation: Distinct otalgia (discomfort clearly referable to the ears that interferes with or precludes normal activity or sleep)."]
[select name="Qeleven" value="Temperature IS NOT above 39 degrees Celsius/102.2 Fahrenheit. Moderate to severe otalgia IS NOT present.=0|Temperature at or above 39 Celsius/102.2 Fahrenheit.=5|Moderate to severe otalgia.=5|Temperature at or above 39 Celsius/102.2 Fahrenheit AND Moderate to severe otalgia is present.=5"] <-- 11. Severity?
[conditional field="Q5|Q6|Q7|Q8|Q9|Qten" condition="((Q5).is('One or both tympanic membranes bulging.')||(Q6).is('Limited or absent mobility of one or both tympanic membranes.')||(Q7).is('Otorrhea at one or both ears.')||(Q8).is('Air fluid level seen at one or both tympanic membranes.'))&&((Q9).is('Distinct erythema at one or both tympanic membranes.')||(Qten).is('Otalgia present that interferes with or precludes normal activity or sleep.'))"]Middle ear effusion and middle ear inflammation are present. [calc value="score=(Q1)+(Q2)+(Q3)+(Q4)+(Qeleven)+2;score>10057?'certain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>10054?'uncertain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>10052?'certain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>10049?'uncertain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>10047?'certain diagnosis, severe illness: ceftriaxone 3 days':score>10044?'uncertain diagnosis, severe illness: ceftriaxone 3 days':score>10042?'certain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days (6-7 days if age 6+)':score>10039?'uncertain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days (6-7 days if age 6+)':score>10037?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10034?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10032?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>10029?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>10027?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10024?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10022?'certain diagnosis, nonsevere illness: amoxicillin 10 days (6-7 days if age 6+)':score>10019?'uncertain diagnosis, nonsevere illness: amoxicillin 10 days (6-7 days if age 6+)':score>10017?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10014?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10012?'certain diagnosis, nonsevere illness: 48-72 hour observation or azithromycin 5 days or clarithromycin 10 days':score>10009?'uncertain diagnosis, nonsevere illness: 48-72 hour observation or azithromycin 5 days or clarithromycin 10 days':score>10007?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10004?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10002?'certain diagnosis, nonsevere illness: 48-72 hour observation or amoxicillin 10 days (6-7 days if age 6+)':score>9999?'uncertain diagnosis, nonsevere illness: 48-72 hour observation or amoxicillin 10 days (6-7 days if age 6+)':score>1057?'certain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>1054?'uncertain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>1052?'certain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>1049?'uncertain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>1047?'certain diagnosis, severe illness: ceftriaxone 3 days':score>1044?'uncertain diagnosis, severe illness: ceftriaxone 3 days':score>1042?'certain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>1039?'uncertain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>1037?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1034?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1032?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>1029?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>1027?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1024?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1022?'certain diagnosis, nonsevere illness: amoxicillin 10 days':score>1019?'uncertain diagnosis, nonsevere illness: amoxicillin 10 days':score>1017?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1014?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1012?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>1009?'uncertain diagnosis, nonsevere illness: observation 48-72 hours or azithromycin 5 days or clarithromycin 10 days':score>1007?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1004?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1002?'certain diagnosis, nonsevere illness: amoxicillin 10 days':score>999?'uncertain diagnosis, nonsevere illness: observation 48-72 hours or amoxicillin 10 days':score>157?'certain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>154?'uncertain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>152?'certain diagnosis, nonsevere illness: clindamycin 10 days':score>149?'uncertain diagnosis, nonsevere illness: clindamycin 10 days':score>147?'certain diagnosis, severe illness: ceftriaxone 3 days':score>144?'uncertain diagnosis, severe illness: ceftriaxone 3 days':score>142?'certain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>139?'uncertain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>137?'certain diagnosis, severe illness: consider tympanocentesis or clindamycin 10 days':score>134?'uncertain diagnosis, severe illness: consider tympanocentesis or clindamycin 10 days':score>132?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>129?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>127?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>124?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>122?'certain diagnosis, nonsevere illness: amoxicillin 10 days':score>119?'uncertain diagnosis, nonsevere illness: amoxicillin 10 days':score>117?'certain diagnosis, severe illness: consider tympanocentesis or clindamycin':score>114?'uncertain diagnosis, severe illness: consider tympanocentesis or clindamycin 10 days':score>112?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>109?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>107?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>104?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>102?'certain diagnosis, nonsevere illness: amoxicillin 10 days':'uncertain diagnosis, nonsevere illness: amoxicillin 10 days'" memo="interpretation"][/conditional][conditional field="Q5|Q6|Q7|Q8|Q9|Qten" condition="((Q5).is('One or both tympanic membranes bulging.')||(Q6).is('Limited or absent mobility of one or both tympanic membranes.')||(Q7).is('Otorrhea at one or both ears.')||(Q8).is('Air fluid level seen at one or both tympanic membranes.'))&&((Q9).is('No distinct erythema at either tympanic membrane.')&&(Qten).is('Distinct oltalgia is not present.'))"]Middle ear effusion is present and middle ear inflammation is absent. [calc value="score=(Q1)+(Q2)+(Q3)+(Q4)+(Qeleven)+1;score>10057?'certain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>10054?'uncertain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>10052?'certain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>10049?'uncertain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>10047?'certain diagnosis, severe illness: ceftriaxone 3 days':score>10044?'uncertain diagnosis, severe illness: ceftriaxone 3 days':score>10042?'certain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days (6-7 days if age 6+)':score>10039?'uncertain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days (6-7 days if age 6+)':score>10037?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10034?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10032?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>10029?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>10027?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10024?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10022?'certain diagnosis, nonsevere illness: amoxicillin 10 days (6-7 days if age 6+)':score>10019?'uncertain diagnosis, nonsevere illness: amoxicillin 10 days (6-7 days if age 6+)':score>10017?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10014?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10012?'certain diagnosis, nonsevere illness: 48-72 hour observation or azithromycin 5 days or clarithromycin 10 days':score>10009?'uncertain diagnosis, nonsevere illness: 48-72 hour observation or azithromycin 5 days or clarithromycin 10 days':score>10007?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10004?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10002?'certain diagnosis, nonsevere illness: 48-72 hour observation or amoxicillin 10 days (6-7 days if age 6+)':score>9999?'uncertain diagnosis, nonsevere illness: 48-72 hour observation or amoxicillin 10 days (6-7 days if age 6+)':score>1057?'certain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>1054?'uncertain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>1052?'certain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>1049?'uncertain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>1047?'certain diagnosis, severe illness: ceftriaxone 3 days':score>1044?'uncertain diagnosis, severe illness: ceftriaxone 3 days':score>1042?'certain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>1039?'uncertain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>1037?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1034?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1032?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>1029?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>1027?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1024?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1022?'certain diagnosis, nonsevere illness: amoxicillin 10 days':score>1019?'uncertain diagnosis, nonsevere illness: amoxicillin 10 days':score>1017?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1014?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1012?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>1009?'uncertain diagnosis, nonsevere illness: observation 48-72 hours or azithromycin 5 days or clarithromycin 10 days':score>1007?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1004?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1002?'certain diagnosis, nonsevere illness: amoxicillin 10 days':score>999?'uncertain diagnosis, nonsevere illness: observation 48-72 hours or amoxicillin 10 days':score>157?'certain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>154?'uncertain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>152?'certain diagnosis, nonsevere illness: clindamycin 10 days':score>149?'uncertain diagnosis, nonsevere illness: clindamycin 10 days':score>147?'certain diagnosis, severe illness: ceftriaxone 3 days':score>144?'uncertain diagnosis, severe illness: ceftriaxone 3 days':score>142?'certain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>139?'uncertain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>137?'certain diagnosis, severe illness: consider tympanocentesis or clindamycin 10 days':score>134?'uncertain diagnosis, severe illness: consider tympanocentesis or clindamycin 10 days':score>132?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>129?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>127?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>124?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>122?'certain diagnosis, nonsevere illness: amoxicillin 10 days':score>119?'uncertain diagnosis, nonsevere illness: amoxicillin 10 days':score>117?'certain diagnosis, severe illness: consider tympanocentesis or clindamycin':score>114?'uncertain diagnosis, severe illness: consider tympanocentesis or clindamycin 10 days':score>112?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>109?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>107?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>104?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>102?'certain diagnosis, nonsevere illness: amoxicillin 10 days':'uncertain diagnosis, nonsevere illness: amoxicillin 10 days'" memo="interpretation"][/conditional][conditional field="Q5|Q6|Q7|Q8|Q9|Qten" condition="((Q5).is('No bulging tympanic membrane.')&&(Q6).is('Normal mobility of both tympanic membranes.')&&(Q7).is('No otorrhea present.')&&(Q8).is('No air fluid level seen.'))&&((Q9).is('Distinct erythema at one or both tympanic membranes.')||(Qten).is('Otalgia present that interferes with or precludes normal activity or sleep.'))"]Middle ear effusion is absent and middle ear inflammation is present. [calc value="score=(Q1)+(Q2)+(Q3)+(Q4)+(Qeleven)+1;score>10057?'certain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>10054?'uncertain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>10052?'certain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>10049?'uncertain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>10047?'certain diagnosis, severe illness: ceftriaxone 3 days':score>10044?'uncertain diagnosis, severe illness: ceftriaxone 3 days':score>10042?'certain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days (6-7 days if age 6+)':score>10039?'uncertain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days (6-7 days if age 6+)':score>10037?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10034?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10032?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>10029?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>10027?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10024?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10022?'certain diagnosis, nonsevere illness: amoxicillin 10 days (6-7 days if age 6+)':score>10019?'uncertain diagnosis, nonsevere illness: amoxicillin 10 days (6-7 days if age 6+)':score>10017?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10014?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10012?'certain diagnosis, nonsevere illness: 48-72 hour observation or azithromycin 5 days or clarithromycin 10 days':score>10009?'uncertain diagnosis, nonsevere illness: 48-72 hour observation or azithromycin 5 days or clarithromycin 10 days':score>10007?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10004?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10002?'certain diagnosis, nonsevere illness: 48-72 hour observation or amoxicillin 10 days (6-7 days if age 6+)':score>9999?'uncertain diagnosis, nonsevere illness: 48-72 hour observation or amoxicillin 10 days (6-7 days if age 6+)':score>1057?'certain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>1054?'uncertain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>1052?'certain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>1049?'uncertain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>1047?'certain diagnosis, severe illness: ceftriaxone 3 days':score>1044?'uncertain diagnosis, severe illness: ceftriaxone 3 days':score>1042?'certain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>1039?'uncertain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>1037?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1034?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1032?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>1029?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>1027?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1024?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1022?'certain diagnosis, nonsevere illness: amoxicillin 10 days':score>1019?'uncertain diagnosis, nonsevere illness: amoxicillin 10 days':score>1017?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1014?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1012?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>1009?'uncertain diagnosis, nonsevere illness: observation 48-72 hours or azithromycin 5 days or clarithromycin 10 days':score>1007?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1004?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1002?'certain diagnosis, nonsevere illness: amoxicillin 10 days':score>999?'uncertain diagnosis, nonsevere illness: observation 48-72 hours or amoxicillin 10 days':score>157?'certain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>154?'uncertain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>152?'certain diagnosis, nonsevere illness: clindamycin 10 days':score>149?'uncertain diagnosis, nonsevere illness: clindamycin 10 days':score>147?'certain diagnosis, severe illness: ceftriaxone 3 days':score>144?'uncertain diagnosis, severe illness: ceftriaxone 3 days':score>142?'certain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>139?'uncertain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>137?'certain diagnosis, severe illness: consider tympanocentesis or clindamycin 10 days':score>134?'uncertain diagnosis, severe illness: consider tympanocentesis or clindamycin 10 days':score>132?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>129?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>127?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>124?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>122?'certain diagnosis, nonsevere illness: amoxicillin 10 days':score>119?'uncertain diagnosis, nonsevere illness: amoxicillin 10 days':score>117?'certain diagnosis, severe illness: consider tympanocentesis or clindamycin':score>114?'uncertain diagnosis, severe illness: consider tympanocentesis or clindamycin 10 days':score>112?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>109?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>107?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>104?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>102?'certain diagnosis, nonsevere illness: amoxicillin 10 days':'uncertain diagnosis, nonsevere illness: amoxicillin 10 days'" memo="interpretation"][/conditional][conditional field="Q5|Q6|Q7|Q8|Q9|Qten" condition="((Q5).is('No bulging tympanic membrane.')&&(Q6).is('Normal mobility of both tympanic membranes.')&&(Q7).is('No otorrhea present.')&&(Q8).is('No air fluid level seen.'))&&((Q9).is('No distinct erythema at either tympanic membrane.')&&(Qten).is('Distinct oltalgia is not present.'))"]Middle ear effusion and middle ear inflammation are absent. [calc value="score=(Q1)+(Q2)+(Q3)+(Q4)+(Qeleven);score>10057?'certain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>10054?'uncertain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>10052?'certain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>10049?'uncertain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>10047?'certain diagnosis, severe illness: ceftriaxone 3 days':score>10044?'uncertain diagnosis, severe illness: ceftriaxone 3 days':score>10042?'certain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days (6-7 days if age 6+)':score>10039?'uncertain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days (6-7 days if age 6+)':score>10037?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10034?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10032?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>10029?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>10027?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10024?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10022?'certain diagnosis, nonsevere illness: amoxicillin 10 days (6-7 days if age 6+)':score>10019?'uncertain diagnosis, nonsevere illness: amoxicillin 10 days (6-7 days if age 6+)':score>10017?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10014?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10012?'certain diagnosis, nonsevere illness: 48-72 hour observation or azithromycin 5 days or clarithromycin 10 days':score>10009?'uncertain diagnosis, nonsevere illness: 48-72 hour observation or azithromycin 5 days or clarithromycin 10 days':score>10007?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10004?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10002?'certain diagnosis, nonsevere illness: 48-72 hour observation or amoxicillin 10 days (6-7 days if age 6+)':score>9999?'uncertain diagnosis, nonsevere illness: 48-72 hour observation or amoxicillin 10 days (6-7 days if age 6+)':score>1057?'certain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>1054?'uncertain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>1052?'certain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>1049?'uncertain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>1047?'certain diagnosis, severe illness: ceftriaxone 3 days':score>1044?'uncertain diagnosis, severe illness: ceftriaxone 3 days':score>1042?'certain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>1039?'uncertain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>1037?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1034?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1032?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>1029?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>1027?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1024?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1022?'certain diagnosis, nonsevere illness: amoxicillin 10 days':score>1019?'uncertain diagnosis, nonsevere illness: amoxicillin 10 days':score>1017?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1014?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1012?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>1009?'uncertain diagnosis, nonsevere illness: observation 48-72 hours or azithromycin 5 days or clarithromycin 10 days':score>1007?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1004?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1002?'certain diagnosis, nonsevere illness: amoxicillin 10 days':score>999?'uncertain diagnosis, nonsevere illness: observation 48-72 hours or amoxicillin 10 days':score>157?'certain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>154?'uncertain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>152?'certain diagnosis, nonsevere illness: clindamycin 10 days':score>149?'uncertain diagnosis, nonsevere illness: clindamycin 10 days':score>147?'certain diagnosis, severe illness: ceftriaxone 3 days':score>144?'uncertain diagnosis, severe illness: ceftriaxone 3 days':score>142?'certain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>139?'uncertain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>137?'certain diagnosis, severe illness: consider tympanocentesis or clindamycin 10 days':score>134?'uncertain diagnosis, severe illness: consider tympanocentesis or clindamycin 10 days':score>132?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>129?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>127?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>124?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>122?'certain diagnosis, nonsevere illness: amoxicillin 10 days':score>119?'uncertain diagnosis, nonsevere illness: amoxicillin 10 days':score>117?'certain diagnosis, severe illness: consider tympanocentesis or clindamycin':score>114?'uncertain diagnosis, severe illness: consider tympanocentesis or clindamycin 10 days':score>112?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>109?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>107?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>104?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>102?'certain diagnosis, nonsevere illness: amoxicillin 10 days':'uncertain diagnosis, nonsevere illness: amoxicillin 10 days'" memo="interpretation"][/conditional]
acute otitis media tool
Summary:  This decision tool applies the American Academy of Pediatrics Guideline Subcommittee on Management of Acute Otitis Media (2004) Pediatrics 113: 1451-65 for diagnosing and managing acute otitis media.
A similar paper-based encounter tool is available at Ebell (2004) Am Fam Physician 69: 2896-98 .

<-- 1. Age group?
<-- 2. Visit timing?
<-- 3. Penicillin allergy?
AAFP information on drug allergy Reidl (2003) Am Fam Physician 68: 1781-91

<-- 4. Acute onset? (Acute onset: Recent, usually abrupt onset of signs and symptoms of middle-ear inflammation and effusion.)
American Academy of Pediatrics Slidebook of otoscope images
Middle ear effusion signs.

<-- 5. Bulging of the tympanic membrane?
<-- 6. Limited or absent mobility of the tympanic membrane?
<-- 7. Otorrhea?
<-- 8. Air fluid level?
Middle ear inflammation signs.

<-- 9. Distinct erythema at tympanic membrane?
<-- 10. Significant otalgia? Symptom of middle ear inflammation: Distinct otalgia (discomfort clearly referable to the ears that interferes with or precludes normal activity or sleep).
<-- 11. Severity?
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