Acute otitis media

Last reviewed: 26 Apr 2022
Last updated: 09 Sep 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • otalgia
  • preceding upper respiratory symptoms
  • bulging tympanic membrane
  • myringitis
More key diagnostic factors

Other diagnostic factors

  • irritability
  • sleep disturbance
  • fever
  • decreased appetite
Other diagnostic factors

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)
  • dummy use
  • environmental tobacco smoke
  • lower socioeconomic status
  • craniofacial anomaly
  • immunological deficiency
More risk factors

Diagnostic investigations

1st investigations to order

  • no initial test
More 1st investigations to order

Investigations to consider

  • pneumatic otoscopy
  • tympanometry
  • acoustic reflectometry
  • bacterial culture of middle ear contents
More investigations to consider

Treatment algorithm

INITIAL

suspected AOM

ACUTE

confirmed AOM

Contributors

Authors

Carlos E. Armengol, MD

Pediatric Associates of Charlottesville PLC

Assistant Clinical Professor of Pediatrics

University of Virginia Health System

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.

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