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
Carlos E. Armengol, MD
Pediatric Associates of Charlottesville PLC
Assistant Clinical Professor of Pediatrics
University of Virginia Health System
CEA is an author of a reference cited in this topic.
Dr Carlos E. Armengol would like to gratefully acknowledge the late Professor J. Owen Hendley, a previous contributor to this topic.
JOH declared that he had no competing interests.
Ozgur Yigit, MD
Istanbul Training and Research Hospital
OY declares that he has no competing interests.
Peter Bull, MB FRCS
Retired Consultant Paediatric Otolaryngologist
Formerly at Sheffield Children's Hospital
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
University of Virginia Medical College
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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