In Reply

Acute Otitis Media: A Structured Approach Dr. med. Jan Peter Thomas, Prof. Dr. med. Reinhard Berner, Prof. Dr. med. Dr. h.c. Thomas Zahnert, Prof. Dr. med. Stefan Dazert in issue 9/2014

We thank Aschendorff and Maier for the additions to our CME article and agree with the detailed recommendations from the article published by Rubin (1) in 2010, which we cited in our article. The main objective of our CME article was to explain how to distinguish uncomplicated AOM from AOM with complicating factors, and the subsequent, literature-based, presentation of the therapeutic approach in uncomplicated AOM in otherwise healthy patients. A detailed discourse of individually adequate therapy of AOM in patients with existing risk factors—which indubitably includes patients with cochlear implants—with all its particularities would have exceeded the scope and word count of this article and was therefore not our primary objective.

Everyone treating AOM absolutely has to be aware of the risks of AOM in CI patients in the form of threatening meningitis, implant infection, and, possibly, extrusion. All these necessitate immediate therapeutic intervention, especially in the form of immediate antibiotic treatment. Even though the existing literature on the topic does not go beyond evidence level IV (1–3), after the initial healing phase, two months after implantation surgery, intravenous administration of antibiotics will need to be assessed carefully in each individual case, and contact with the treating CI center should be established . In suspected purulent AOM, paracentesis enables not only drainage of the middle ear but also swabbing and microbiological analysis, and therefore rapid initiation of treatment with the appropriate antibiotic, based on resistance tests results; however, this must not delay the start of empirical treatment when a diagnosis of AOM is made in this patient group (2).

DOI: 10.3238/arztebl.2014.0545b

Dr. med. Jan Peter Thomas

Universitätsklinik für Hals-,
Nasen- und Ohrenheilkunde,

Kopf- und Halschirurgie
der Ruhr-Universität Bochum

am St. Elisabeth Hospital

Conflict of interest statement

The authors of both contributions declare that no conflict of interest exists.

References

1. Rubin LG: Prevention and treatment of meningitis and acute otitis media in children with cochlear implants. Otol Neurotol 2010; 31: 1331–3.

2. Rubin LG, Papsin B: Committee on Infectious Diseases and Section on Otolaryngology–Head and Neck Surgery. Cochlear implants in children: surgical site infections and prevention and treatment of acute otitis media and meningitis Pediatrics 2010; 126: 381–91.

3. Lalwani AK, Noel LC: Does meningitis after cochlear implantation remain a concern in 2011? Otol Neurotol 2011; 33: 93–5.

4. Thomas JP, Berner R, Zahnert T, Dazert S: Acute otitis media: a structured approach. Dtsch Arztebl Int 2014; 111: 151–60.