Acute otitis media
Acute otitis media is a suppurative middle ear infection, mostly in young children, diagnosed by otoscopy showing a bulging, erythematous tympanic membrane with an effusion, and it is treated with observation or amoxicillin depending on age and severity.
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What this article covers
- Overview
Suppurative middle ear infection: acute otitis media (AOM) is a suppurative infection of the middle ear cavity, most often following an upper respiratory infection that produces eustachian tube…
- Epidemiology
Peak incidence in infancy and toddlerhood: rate peaks between 6 and 12 months of age, with most children affected before age 2; about 60% of children develop one or more episodes before 4 years of age.
- Risk factors
Recent or concurrent upper respiratory infection: nasopharyngeal inflammation obstructs the eustachian tube isthmus and is the usual antecedent event.
- Pathophysiology
Eustachian tube obstruction is the initiating event: viral upper respiratory infection causes mucosal edema that narrows the eustachian tube isthmus, its narrowest portion.
- Clinical features
Diagnosis requires both an inflamed and a bulging tympanic membrane plus an effusion: the defining triad is (1) middle ear effusion, (2) signs of acute inflammation of the tympanic membrane (bulging…
- Differential diagnosis
Otitis media with effusion: fluid in the middle ear without bulging, erythema, or other acute inflammatory signs; the membrane is dull and retracted, not bulging; see otitis media with effusion.
- Diagnosis
AOM is a clinical diagnosis; no confirmatory laboratory test exists: the diagnosis rests on otoscopic examination and history alone, using the triad above (acute onset, middle ear effusion, and…
- Management
First decide observation versus antibiotics, based on age, laterality, and severity: for a child older than 6 months with mild, unilateral AOM and reliable follow-up, either observation with close…
- Complications
Tympanic membrane perforation: the most common complication; usually heals spontaneously but can lead to recurrent otorrhea; see tympanic membrane perforation.
- Prognosis
Excellent overall outcome: most episodes resolve without sequelae, whether observed or treated with antibiotics.
- Prevention
Breastfeeding: exclusive breastfeeding is protective and should be encouraged.
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Related articles
- Otitis media with effusion
Otitis media with effusion is middle-ear fluid persisting without signs of acute infection, most often in young children after an upper respiratory infection or acute otitis media, managed mainly with observation and reserving tympanostomy tubes for persistent hearing loss.
- Otitis externa
Otitis externa is diffuse inflammation of the external auditory canal, usually bacterial (Pseudomonas or Staphylococcus aureus) and diagnosed clinically by tragal tenderness and canal erythema with otorrhea. Uncomplicated disease is treated with topical antibiotic-steroid otic drops for 7 days, while malignant (necrotizing) otitis externa in a diabetic or immunocompromised patient is skull-base osteomyelitis requiring systemic antipseudomonal therapy and urgent otolaryngology referral.
- Mastoiditis
Acute mastoiditis is a suppurative infection of the mastoid air cells, almost always arising as an extension of untreated or inadequately treated acute otitis media. It is diagnosed clinically by postauricular erythema, tenderness, and swelling with the auricle displaced anteriorly, and is treated with intravenous antibiotics escalating to myringotomy or mastoidectomy when abscess or complications are present.
- Cholesteatoma
Cholesteatoma is an abnormal growth of keratinizing squamous epithelium in the middle ear that erodes the ossicles, mastoid, and adjacent skull base; it is confirmed on otoscopy, staged by CT, and requires mastoidectomy with tympanoplasty because no medical therapy is curative.
- Chronic suppurative otitis media
Chronic suppurative otitis media is continuous otorrhea through a perforated tympanic membrane for more than six weeks without systemic symptoms. Management starts with topical fluoroquinolone ear drops and aural toilet, escalating to systemic antibiotics or tympanoplasty for refractory disease or cholesteatoma.
- Hearing loss
Hearing loss is evaluated with the Weber and Rinne tuning fork tests to sort conductive from sensorineural loss at the bedside, then confirmed with audiometry; treatment ranges from cerumen removal or hearing aids to urgent oral prednisone and otolaryngology referral for sudden sensorineural loss.
- Streptococcal pharyngitis
Streptococcal pharyngitis is an acute infection of the tonsils and pharynx caused by group A Streptococcus pyogenes, presenting with rapid-onset sore throat, fever, tonsillar exudates, and tender anterior cervical lymphadenopathy without cough; diagnosis relies on the Centor criteria to guide rapid antigen testing, and treatment with penicillin or amoxicillin prevents suppurative complications and acute rheumatic fever.
- Tympanic membrane perforation
A full-thickness defect in the eardrum from trauma or infection, causing sudden ear pain, conductive hearing loss, and otorrhea. Diagnosis is by otoscopy. Most heal spontaneously with dry-ear precautions; a draining ear is treated with ofloxacin otic drops, and a perforation that fails to close by 3 months is referred for myringoplasty or tympanoplasty.