A new way to treat ear infections

Nevertheless, I encourage all to find an opportunity to attend a CME course on AOM diagnosis and I hope that resident training programs will incorporate more effective teaching on AOM diagnosis. I recommend high-dose amoxicillin/clavulanate as the treatment of choice for AOM; if it is not tolerated, then one of the preferred cephalosporins endorsed by the AAP guideline should be chosen.

I recommend that resident training programs include tympanocentesis as part of the curriculum. Why are residents taught how to do a spinal tap, arterial artery puncture, and lung tap but not an ear tap? I also recommend that practicing pediatricians gain the skill to perform tympanocentesis as well. I recognize that some just won’t have the hand/eye coordination or steady hand needed, so it’s not for everyone. However, especially in group practices, a few trained providers could become an internal referral resource for getting the procedure done.

Arguments about malpractice are a smokescreen. The risks of tympanocentesis are no greater than venipuncture in trained and skilled hands. It is included as a standard procedure for pediatricians in our state without any additional malpractice insurance costs. And Dr. Casey and I have effectively managed to get the procedure done when a patient needs it without blowing our schedules off the map and raising the ire of patients and staff. It just takes a commitment.

It would be convenient to refer to an ENT doctor for a tympanocentesis, but most ENT doctors have not been trained to do the procedure while the child is awake and prefer to have the child asleep. Also, try to get a child in for an appointment with an ENT with no notice on the same day! Moreover, ENT doctors have been trained that if an ear tap is needed then it is advisable to go ahead and put in an ear tube.

Because of the success of this research, our center received a renewal of support from NIH in 2012 to continue the study through 2017. Several pediatric practices in Rochester are part of the research – Long Pond Pediatrics, Westfall Pediatrics, Sunrise Pediatrics, Lewis Pediatrics, and Pathway Pediatrics – as well as Dr. Margo Benoit of the department of otolaryngology at the University of Rochester and Dr. Frank Salamone and Dr. Kevin Kozara of the Rochester Otolaryngology Group, which is affiliated with Rochester General Hospital.

Dr. Pichichero, a specialist in pediatric infectious diseases, is director of the Rochester (N.Y.) General Hospital Research Institute. He is also a pediatrician at Legacy Pediatrics in Rochester. He said he had no relevant financial conflicts of interest to disclose.