Observation Option for AOM: A Second Look

Frankly, I find it embarrassing that with a condition as common as AOM, pediatricians and family physicians receive so little training in diagnosing it and, therefore, just don't do a good job. In otitis media workshops that include testing for competency in diagnosis (Outcomes Management Educational Workshops, West Palm Beach, Fla.), I found that physicians got the diagnosis of AOM wrong at least 50% of the time on video presentation testing. And that was without wax, under ideal classroom conditions.

Diagnosing otitis media needs to become a critical part of medical education, and physicians in practice should be retrained via CME courses. Pharmaceutical companies no longer sponsor those, so now the professional societies such as the American Academy of Pediatrics, the American Academy of Family Physicians, and the nursing organizations need to step up.

With the new evidence from the two well-controlled trials, I don't see how any clinician can withhold antibiotic treatment in good conscience. AOM is a painful condition that infants and toddlers are too young to explain to us. Can you imagine asking an adult to agree to withholding effective treatment when they are in pain and propose they take acetaminophen instead? Or can you imagine telling an adult who seeks care for an earache that the diagnosis is uncertain after examination, so the recommendation is to “observe”?

As advocates for our pediatric patients, how in the world can we allow a child to remain in severe pain for 24–48 hours longer than is necessary and keep parents up all night and away from work for 2–3 extra days?

Once everyone learns how to better diagnose AOM, we will stop overprescribing antibiotics for those children who don't have the condition. For the rest, I contend that treatment is a moral imperative.