Otitis Media Prevention

Influenza Vaccine annually
Pneumococcal Conjugate Vaccine (e.g. Prevnar 13)
1. Reduces Incidence of pneumococcal Otitis Media
2. Jacobs (2002) J Pediatr 141:287-93 [PubMed]
Eliminate passive Tobacco smoke exposure
Avoid bottle propping
Avoid Pacifiers
Consider diagnosis and management of comorbid chronic Allergic Rhinitis
Xylitol gum
1. Consider in children with recurrent Otitis Media and old enough to chew gum
2. Chew 2 pieces for at least 5 minutes each, 5 times daily after meals
3. Azarpazhooh (2011) Cochrane Database Syst Rev (11): CD007095 [PubMed]
Tympanostomy Tube indications
1. Three Otitis Media episodes in 6 months OR 4 episodes in 1 year AND
2. Last episode within prior 6 months

Protocol
Antibiotic Prophylaxis for Recurrent Otitis Media (not recommended, historical purpose only)

Antibiotic prophylaxis is largely replaced by Tympanostomy Tubes
Antibiotics prophylaxis for recurrent Otitis Media is not recommended
1. Lieberthal (2013) Pediatrics 131(3): e964-99 [PubMed]
Antibiotic prophylaxis reduced recurrent Otitis Media episodes by 50%, but at the expense of Antibiotic Resistance
1. Antibiotic prophylaxis selects for Antibiotic resistant Streptococcus Pneumoniae
Antibiotics were previously indicated for
1. Three distinct Otitis Media episodes in 6 months
2. Four distinct Otitis Media episodes in 12 months
Prior protocols use Amoxicillin or Sulfisoxazole for up to 6 months