Acute otitis media 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.
Acute otitis media (AOM) is an infection involving the middle ear space and is a common complication of viral respiratory illnesses.
History and exam
Key diagnostic factors
- preceding upper respiratory symptoms
- bulging tympanic membrane
Other diagnostic factors
- sleep disturbance
- decreased appetite
- 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
1st investigations to order
- no initial test
Investigations to consider
- pneumatic otoscopy
- acoustic reflectometry
- bacterial culture of middle ear contents
- Otitis media with effusion
- Evaluation and management of well-appearing febrile infants 8 to 60 days old
- Otitis media (acute): antimicrobial prescribing
Middle ear infection
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