Otitis Media in Young Children
소아 중이염
Published April 9, 2025
N Engl J Med 2025;392:1418-1426
This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations.
An otherwise-healthy 9-month-old girl in whom symptoms of an upper respiratory tract infection had developed 4 days earlier presents with a 1-day history of increased fussiness and difficulty sleeping reported by a parent. On examination, she is afebrile and slightly fussy. Her right tympanic membrane, which can be visualized only partially owing to the presence of cerumen, appears opacified. How would you treat this child?
The Clinical Problem
Acute otitis media remains one of the most frequently diagnosed infectious diseases in children younger than 2 years of age. By 2 years of age, 41% of children will have had at least one episode of acute otitis media and 13% will have had at least three episodes.1 Although the incidence of acute otitis media, and particularly of recurrent and refractory cases,2 has been decreasing,3,4 approximately 15 million cases are diagnosed each year in the United States.3 The decrease in the incidence of acute otitis media, especially among children younger than 2 years of age,4 is likely to be attributable to universal vaccination with pneumococcal conjugate vaccines5 and to increased stringency in the diagnostic criteria.6 Exposure to large numbers of other children (e.g., in day care), male sex, shorter duration of breast-feeding, exposure to tobacco smoke, Down’s syndrome, and immunologic deficiencies (e.g., hypogammaglobulinemia) are associated with an increased risk of acute otitis media.7-9
Key Clinical Points
Otitis Media in Young Children
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Acute otitis media is a bacterial infection that occurs almost exclusively after a viral upper respiratory tract infection.
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Common pathogens include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
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Bulging of the tympanic membrane is a defining feature.
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High-dose amoxicillin (80 to 90 mg per kilogram of body weight per day, divided into two doses) remains the first-line treatment. Amoxicillin–clavulanate therapy warrants consideration in children in whom H. influenzae is likely to predominate (i.e., those who have received antibiotics in the previous 30 days, have conjunctivitis–otitis syndrome, or have spontaneous rupture of the tympanic membrane).
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Treatment with antibiotics for 10 days resulted in less treatment failure and less use of rescue antibiotics than treatment for 5 days.
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Tympanocentesis is indicated in children with acute otitis media who have had treatment failure with multiple rounds of antibiotic therapy.
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Among children with recurrent acute otitis media, the incidence of acute otitis media during a 2-year period was similar among those who had placement of a tympanostomy tube and those who received episodic antibiotic treatment.
Source JNEJM 4/10/205, there is more information
Copyright drleepediatrics.com 1/28/2026
어린이 중이염
게재일: 2025년 4월 9일
N Engl J Med 2025;392:1418-1426
이 저널 특집 기사는 흔한 임상 문제를 강조하는 사례 소개로 시작합니다.
다양한 치료 전략을 뒷받침하는 근거가 제시된 후, 관련 지침이 있는 경우 해당 지침에 대한 검토가 이어집니다. 기사는 저자의 임상적 권고로 마무리됩니다.
기저 질환이 없는 9개월 된 여아가 4일 전부터 상기도 감염 증상이 나타났고, 보호자는 1일 전부터 아이가 더 보채고 잠을 잘 못 잔다고 보고했습니다. 진찰 결과, 아이는 열이 없고 약간 보채는 상태였습니다. 귀지 때문에 부분적으로만 보이는 오른쪽 고막은 불투명해 보였습니다. 이 아이를 어떻게 치료하시겠습니까?
임상 문제
급성 중이염은 2세 미만 어린이에게서 가장 흔하게 진단되는 감염성 질환 중 하나입니다.
2세가 될 때까지 어린이의 41%는 최소 한 번의 급성 중이염을 앓고, 13%는 최소 세 번의 급성 중이염을 앓습니다.
1 급성 중이염, 특히 재발성 및 난치성 사례의 발생률은 감소하고 있지만,
2,3 미국에서는 매년 약 1,500만 건의 사례가 진단됩니다.
3 급성 중이염 발생률 감소, 특히 2세 미만 어린이의 발생률 감소는 폐렴구균 접합 백신 접종5 및 진단 기준 강화6에 기인하는 것으로 보입니다. 많은 어린이와의 접촉(예: 어린이집), 남성, 짧은 모유 수유 기간, 담배 연기 노출, 다운 증후군, 면역 결핍(예: 저감마글로불린혈증)은 급성 중이염 위험 증가와 관련이 있습니다.7-9