Resumen
Definition
History and exam
Key diagnostic factors
- otalgia
- preceding upper respiratory symptoms
- bulging tympanic membrane
- myringitis
Other diagnostic factors
- irritability
- sleep disturbance
- fever
- decreased appetite
Risk factors
- day care attendance
- older siblings
- young age
- family history
- Native American or Native Alaskan
- male sex
- absence of breastfeeding
- supine feedings (bottle propping)
- pacifier use
- environmental tobacco smoke
- lower socioeconomic status
- craniofacial anomaly
- immunologic deficiency
Diagnostic investigations
1st investigations to order
- no initial test
Investigations to consider
- pneumatic otoscopy
- tympanometry
- acoustic reflectometry
- bacterial culture of middle ear contents
Treatment algorithm
suspected AOM
confirmed AOM
Contributors
Authors
Carlos E. Armengol, MD
Pediatric Associates of Charlottesville PLC
Charlottesville
VA
Disclosures
CEA is an author of a reference cited in this topic.
Acknowledgements
Dr Carlos E. Armengol would like to gratefully acknowledge the late Professor J. Owen Hendley, a previous contributor to this topic.
Disclosures
JOH declared that he had no competing interests.
Peer reviewers
Ozgur Yigit, MD
Chief
ENT Department
Istanbul Training and Research Hospital
Istanbul
Turkey
Disclosures
OY declares that he has no competing interests.
Peter Bull, MB FRCS
Retired Consultant Paediatric Otolaryngologist
Formerly at Sheffield Children's Hospital
Sheffield
UK
Disclosures
PB declares that he has no competing interests.
Richard Schwartz, MD
Clinical Professor of Pediatrics
Georgetown University and George Washington University School of Medicine
Professor of Pediatrics
Medical College of Virginia
Clinical Professor
University of Virginia Medical College
Charlottesville
VA
Disclosures
At the time of the peer review, RS declared no competing interests. We have been informed that Dr Schwartz is now deceased.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013 Mar;131(3):e964-99. [Erratum in: Pediatrics. 2014 Feb;133(2):346.]Full text Abstract
Sjoukes A, Venekamp RP, van de Pol AC, et al. Paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs, alone or combined, for pain relief in acute otitis media in children. Cochrane Database Syst Rev. 2016 Dec 15;(12):CD011534.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Otitis media with effusion
- Myringitis
- Mastoiditis
More DifferentialsGuidelines
- Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)
- Otitis media (acute): antimicrobial prescribing
More GuidelinesPatient information
Middle ear infection
How to help your child avoid ear infections
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