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Acute otitis media

Last reviewed: 13 Sep 2025
Last updated: 19 Feb 2025

Summary

Definition

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 investigations

1st investigations to order

  • no initial test
Full details

Investigations 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

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

Declarações

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.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

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.]Texto completo  Resumo

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.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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  • Diagnósticos diferenciais

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  • Diretrizes

    • 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
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