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Acute otitis media

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 1 Apr 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 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

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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.]Full text  Abstract

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.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Acute otitis media images

  • Differentials

    • Otitis media with effusion
    • Myringitis
    • Mastoiditis
    More Differentials

  • Guidelines

    • 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
    More Guidelines

  • Patient information

    Middle ear infection

    How to help your child avoid ear infections

    More Patient information
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