Acute otitis media

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 21 Oct 2024

Last updated: 23 Feb 2023

Acute otitis media (AOM) may present with otalgia, irritability, decreased hearing, anorexia, vomiting, or fever, usually in the presence of an ongoing viral respiratory infection.

Physical examination will reveal a bulging, opacified tympanic membrane with an attenuated light reflex. The membrane may be white, yellow, pink, or red.

Diagnosis is generally made with conventional otoscopy.

Treatment includes pain control with analgesics and might include antibiotics.

Complications include otitis media with effusion, perforation of the tympanic membrane and, rarely, mastoiditis.

Definition

AOM) is an infection involving the middle ear space and is a common complication of viral respiratory illnesses. Although it may occur rarely in adults, AOM predominantly affects children and this will be the focus of this topic.

History and exam

Key diagnostic factors

otalgia
preceding upper respiratory symptoms
bulging tympanic membrane
myringitis

Full details

Other diagnostic factors

irritability
sleep disturbance
fever
decreased appetite

Full details

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

Full details

Diagnostic tests

1st tests to order

no initial test

Full details

Tests to consider

pneumatic otoscopy
tympanometry
acoustic reflectometry
bacterial culture of middle ear contents

Full details

Treatment algorithm

INITIAL

suspected AOM

ACUTE

confirmed AOM

Contributors

Authors

Carlos E. Armengol, MD

Pediatric Associates of Charlottesville PLC

Charlottesville

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

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

Disclosures

At the time of the peer review, RS declared no competing interests. We have been informed that Dr Schwartz is now deceased.

Differentials
- Otitis media with effusion
- Myringitis
- Mastoiditis
More Differentials
Guidelines
- Otitis media (acute): antimicrobial prescribing
- Management of acute otitis media in children six months of age and older
More Guidelines
Patient information
Middle ear infection
How to help your child avoid ear infections
More Patient information
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Acute otitis media

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

suspected AOM

confirmed AOM

Contributors

Authors

Carlos E. Armengol, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Ozgur Yigit, MD

Disclosures

Peter Bull, MB FRCS

Disclosures

Richard Schwartz, MD

Disclosures

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

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