AOM occurs most predominantly between the ages of 3 to 18 months as it commonly affects children 2 years or younger [1]. Moreover, some children are prone to developing recurrent episodes.

Neonates with AOM present with irritability and/or trouble with feeding. Older children with this condition typically have fever, ear pain with ear tugging, conductive hearing loss, and possibly an upper respiratory tract infection (URTI). Other possible symptoms include nausea, emesis, diarrhea, and signs related to URTI. Note that hearing loss is common in both children and adults with AOM as well as otitis media with effusion (OME). Hearing does eventually recover [2].

In cases with tympanic membrane perforation, exudative discharge leaks out for a day or two and the pain quickly subsides.

Risk factors

It is important to consider the risk factors when evaluating the patient. These include prematurity, low birth weight, immunosuppression, allergies, exposure to tobacco and environmental pollutants, colder climates, low socioeconomic status, positive family history, and certain racial backgrounds (such as Native Americans). Children with craniofacial defects and neuromuscular disease may be predisposed as well. Finally, pacifier and bottle use, prone sleeping position, and daycare attendance are other contributing factors.

Physical exam

Notable findings suggestive of inflammation on pneumatic otoscopy include an erythematous tympanic membrane, purulent or serosanguinous effusion in the middle ear, and decreased mobility of the tympanic membrane. Bulging of the membrane is also observed.

• Fever

  >br> Related Cases Disease Acute Otitis Media Ear Infections Symptom/Presentation Crying and Colic Fever and Fever of Unknown Origin Ear Pain Rhinitis”>Rhinitis Sleep Disturbance Specialty General Pediatrics Otolaryngology Age Infant To Learn More To [pediatriceducation.org]

  The combination of these signs with ear pain or fever confirms the diagnosis of AOM. [medicalguidelines.msf.org]

  Review after 48 hours 17. 48 hours review • Earache + fever persists: change to higher antibiotic. • If T.M. is bulging perform myringotomy. [slideshare.net]

  Only fever was an exception, because children with bilateral AOM had fevers more often and fevers that were slightly higher. This was a new finding. [pediatrics.aappublications.org]

  Other symptoms include trouble hearing, fever, fluid drainage from ears, dizziness and congestion. [clinicaladvisor.com]

• Crying

  He woke in the night crying and was difficult to console. He had a fever to 38.7 degrees Celsius and responded to an appropriate dose of acetaminophen. He then returned to sleep. [pediatriceducation.org]

  Sparing of the pars tensa, lack of TM bulging help to differentiate a crying child's red TM from that seen in AOM. [ncbi.nlm.nih.gov]

  – Rapid onset of ear pain (in infants: crying, irritability, sleeplessness, reluctance to nurse) and ear discharge (otorrhoea) or fever. – Other signs such as rhinorrhoea, cough, diarrhoea or vomiting are frequently associated, and may confuse the diagnosis [medicalguidelines.msf.org]

  […] including unusual high-pitched crying, prolonged crying (> #hrs), and crying not otherwise specified; otitis media en The therapeutic indications set out in the marketing authorisation are as follows: ‘Active immunisation against invasive disease, [da.glosbe.com]

  Infants may cry more than usual or pull on their ear. Treatment is pain relief and sometimes requires antibiotics. Most children do not develop any complications and recover well from a middle ear infection. [ada.com]

• Anorexia

  […] acute otitis media A bacterial or viral middle-ear inflammation which is most common in children, which presents with a rapid onset of pain, irritability, anorexia, or vomiting. [medical-dictionary.thefreedictionary.com]

  It is characterized by an acute onset of symptoms (e.g., otalgia, fever, anorexia) with signs of middle ear inflammation (e.g., bulging tympanic membrane, effusion). [amboss.com]

  Assessment History Features: recent onset ear pain (irritability in pre-verbal children), fever, anorexia, vomiting, lethargy. [rch.org.au]

  […] age en The following local reactions and systemic complaints were reported in # % of children within five days after any injection of PROCOMVAX: pain/soreness, erythema, swelling/induration at the injection site; fever (> # °C, rectal equivalent); anorexia [da.glosbe.com]

• Malaise

  The patient may also have systemic features, such as fever and malaise. Although AOM is a common condition in young children, it can affect all age groups, including neonates. [teachmesurgery.com]

  Symptoms Some of the common symptoms of otitis media that a parent should look out for are: Rubbing ear Earache Excessive crying Diarrhoea Fever Vomiting Vertigo Other signs and symptoms of an upper respiratory tract infection (e.g. rhinorrhoea, cough, malaise [healthengine.com.au]

  Malaise. Irritability, crying, poor feeding, restlessness. Fever. Coryza/rhinorrhoea. Vomiting. Signs Examination may reveal: High temperature (febrile convulsions may be associated with the temperature rise in AOM). [patient.info]

• Recent Upper Respiratory Infection

  History of a recent upper respiratory infection is common. Treatment Since AOM is usually self-limiting and resolves in 1 to 2 weeks without antibiotics, the best approach is to watch and wait. [medical-dictionary.thefreedictionary.com]

• Pneumonia

  Prevalence rates of infections due to Streptococcus pneumoniae are declining due to widespread use of the Prevnar vaccine. Streptococcus pneumoniae is often resistant due to penicillin-binding protein alterations. [coreem.net]

  The predominant pathogens of acute otitis media are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. [ncbi.nlm.nih.gov]

• Nasal Congestion

  This was preceded by a 1-week history of nasal congestion, cough, and rhinorrhea. On otoscopy, his left tympanic membrane (TM) appears erythematous, cloudy, bulging, and exudative (Figure 26-1). His left TM fails to move on pneumatic otoscopy. [accessmedicine.mhmedical.com]

  For the following, we asked parents to assess the severity as mild or severe: excessive crying, restless sleep, less playful or active, poor appetite, rhinitis, nasal congestion, cough, hoarse voice, conjunctivitis, mucus vomiting (retching and throwing [pediatrics.aappublications.org]

  […] allergies, but they may prolong middle ear effusion. 26 Oral decongestants may be used to relieve nasal congestion. [aafp.org]

• Loss of Appetite

  Some children may also develop fever, headaches and loss of appetite. Severe cases may cause a burst ear drum and pus may run from the ear. Diagnosis The diagnosis is usually made by a doctor based on the symptoms and physical examination. [ada.com]

  Loss of appetite: This may be most noticeable in young children, especially during bottle feedings. Pressure in the middle ear changes as the child swallows, causing more pain and less desire to eat. [my.clevelandclinic.org]

  While there is fluid in the middle ear, there can be temporary hearing loss. Very rarely, an untreated acute otitis media can lead to permanent hearing loss. [nationwidechildrens.org]

  […] higher Drainage of fluid from the ear Headache Loss of appetite Adults Common signs and symptoms in adults include: Ear pain Drainage of fluid from the ear Trouble hearing When to see a doctor Signs and symptoms of an ear infection can indicate a number [mayoclinic.org]

  Symptoms of ear infection appears mostly after 2 to 7 days of infection the main symptom is feeling of pain in ear other symptoms include loss of appetite, fever, vomiting, fluid draining by ear, fussiness, clumsiness and scandal of ringing in ear [ 6 [omicsonline.org]

• Hypotension

  Viscodyne Syrup is used for Cough, Chest congestion, Acute and chronic bronchopulmonary diseases associated with abnormal mucus secretion, Acute sore throat, Colds, Nasal decongestant, Respiratory tract diseases, Thickened mucus cough, Ear-round allergies, Hypotensive [thepiwox.com]

  […] amoxicillin or penicillin, using the second-generation cephalosporins (cefprozil or cefuroxime-axetil) or a third-generation cephalosporin is acceptable, unless the previous reaction was life-threatening (ie, associated with angioedema, bronchospasm or hypotension [cps.ca]

  Ibuprofen is sometimes used for the treatment of acne because of its anti-inflammatory properties, and has been sold in Japan in topical form for adult acne.[65][66] As with other NSAIDs, ibuprofen may be useful in the treatment of severe orthostatic hypotension [en.wikipedia.org]

• Otalgia

  AOM is an inflammatory process that affects the mucosa of the middle ear and is characterized by fever and otalgia. [pediatriceducation.org]

  It is characterized by an acute onset of symptoms (e.g., otalgia, fever, anorexia) with signs of middle ear inflammation (e.g., bulging tympanic membrane, effusion). [amboss.com]

  Acute suppurative otitis media (ASOM) - A history of gradually increasing otalgia followed by the appearance of a discharge with some reduction in otalgia. Patients sometimes hear/feel a 'pop' just before the discharge appears. [entsho.com]

  The diagnosis is based on acute onset of symptoms such as otalgia and fever, middle ear inflammation such as erythema of the tympanic membrane, and middle ear effusion. [ncbi.nlm.nih.gov]

  Diagnostic criteria Presents as severe otalgia and deafness. The tympanic membrane is red and bulging, perforation can occur leading to purulent otorrhoea. Often the otalgia settles when perforation occurs. [gloshospitals.nhs.uk]

• Ear Discharge

  A 32-year-old woman developed altered consciousness two days after initial symptoms of acute otitis media, with purulent discharge from the right ear. [ncbi.nlm.nih.gov]

  Perforation of the tympanic membrane can occur, with associated purulent ear discharge. Investigations Investigations are rarely required in the evaluation of AOM. [gponline.com]

  Six of the 14 children with fresh discharge in their ear canal had an intact or functionally intact TM. [bmcpediatr.biomedcentral.com]

• Tinnitus

  People with severe tinnitus may have trouble hearing, working and sleeping. At this time, there is no cure for tinnitus and there are no FDA-approved drug treatments for this debilitating condition. [otonomy.com]

  Early symptoms included otalgia, progressive sensorineural hearing loss, and tinnitus with inflammation of the tympanic membrane. During the second week a conductive component emerged resulting in a 60-dB mixed loss in the 2- to 4-kHz region. [ncbi.nlm.nih.gov]

  Learn More About Topic Tinnitus Over 50 million Americans have experienced tinnitus, or ringing in ears, which is the perception of sound without an external source being present. [entnet.org]

• Hearing Problem

  RESULTS: Recurrent acute otitis media subjects reported hearing problems comparable to those of the controls. Pure tone audiometry, at 125-8000 Hz, did not differ between groups. [ncbi.nlm.nih.gov]

  In general, otitis media is not serious and does not normally cause permanent hearing problems if treated properly. Most often, otitis media is cured in the home by means of medication. [hear-it.org]

  This can cause hearing problems and other serious complications. Symptoms The onset of signs and symptoms of ear infection is usually rapid. [mayoclinic.org]

  Can Ear Infections Affect Hearing? Fluid buildup in the middle ear also blocks sound, which can lead to temporary hearing problems. [kidshealth.org]

• Erythematous Tympanic Membrane

  Physical exam Notable findings suggestive of inflammation on pneumatic otoscopy include an erythematous tympanic membrane, purulent or serosanguinous effusion in the middle ear, and decreased mobility of the tympanic membrane. [symptoma.com]

  Erythematous tympanic membranes may be due to viral infection, crying, or efforts to remove cerumen. Fever or irritability may or may not be present. [coreem.net]

  Normal Tympanic Membrane Pink Tympanic Membrane, often seen with fever or upper respiratory tract infections Bulging and erythematous Tympanic Membrane in AOM Otitis Media with Effusion "glue ear" Middle ear effusion Loss of TM landmarks, particularly [rch.org.au]

  On otoscopy, the tympanic membrane (TM) will look erythematous and may be bulging. If this fluid pressure has perforated the TM*, there may be a small tear visible with purulent discharge in the auditory canal. [teachmesurgery.com]

• Meningism

  Meningitis in a patient with a cochlear implant is not necessarily related to the implant. [ncbi.nlm.nih.gov]

  Intracranial complications Meningitis – Sepsis, headache, vomiting, neck rigidity, photophobia and positive Kernig’s sign (pain on meningeal stretch eg chin to chest or straight leg raise). [entsho.com]

  Complications Varying complications of AOM can include mastoiditits, meningitis, facial nerve paresis, intracranial abscess, sigmoid sinus thrombosis, and Chronic Otitis Media. [teachmesurgery.com]

• Dizziness

  Other symptoms include trouble hearing, fever, fluid drainage from ears, dizziness and congestion. [clinicaladvisor.com]

  Clinical course and diagnosis The symptoms of otitis media are earache, discharge from the ear, hearing loss, ear popping, ear fullness, dizziness, and fever. [ncbi.nlm.nih.gov]

  ENT specialists treat conditions such as ear infection, hearing loss, dizziness, ringing in the ears (called tinnitus), ear, face, or neck pain, and more. [entnet.org]

  Hold the bottle in your hand to warm it – cold ear drops can make you feel dizzy. Lie on your side with the affected ear facing up to put the drops in. Gently pull and push your ear to work the drops in. [nhs.uk]

• Vertigo

  Benign Paroxysmal Positional Vertigo (BPPV) Benign paroxysmal positional vertigo, or BPPV, is the most common inner ear problem and cause of vertigo, or false sense of spinning. [entnet.org]

  Videos of doctor Vertigo: causes, symptoms, and treatmen... What are the signs of hearing loss in m... How can I tell if my child has glue ear... [topdoctors.co.uk]

  There are many causes and types of balance disorders including benign positional vertigo, labyrinthitis, vestibular neuritis, and Ménière’s disease. [otonomy.com]

  Clinical features Severe vertigo, nausea, and vomiting Hearing loss Nystagmus towards healthy ear for weeks to months Diagnostics Change of lateralization in Weber's test Audiometry: sensorineural hearing loss Treatment Peripheral facial palsy Otogenic [amboss.com]

• Lethargy

  Assessment History Features: recent onset ear pain (irritability in pre-verbal children), fever, anorexia, vomiting, lethargy. [rch.org.au]

  Systemic signs include fever, irritability, headache, lethargy, anorexia, and vomiting. Diarrhea is also a common sign of AOM in infants. History of a recent upper respiratory infection is common. [medical-dictionary.thefreedictionary.com]

  […] young persons, though it may cause acute respiratory disease in persons of any age group. [5, 6, 7] In northern climates, RSV is normally identified during annual epidemics in the winter and early spring, but it should be considered in any neonate with lethargy [emedicine.medscape.com]

• Screaming

  History Acute Otitis Media The child will present with an acute onset of a painful ear and fever, often following a prodrome of an upper respiratory tract infection A younger child may present more non-specifically with fever, crying/screaming/unsettled [pch.health.wa.gov.au]

  A child who is screaming and distressed may settle remarkably quickly - and then the ear starts to discharge green pus. [patient.info]

  Children with an ear infection display a wide range of symptoms, from none at all, to a high fever, to a screaming earache. [advocarecma.com]

To establish the diagnosis, the clinician will evaluate the patient's clinical manifestations, history, and risk factors. Also crucial is the physical exam including otoscopy. Testing may be warranted in some cases as explained below.

According to clinical practice guidelines set forth by the American Academy of Pediatrics and the American Academy of Family Physicians [3], diagnostic criteria include the presence of tympanic membrane bulging, recent onset of otorrhea (in the absence of external otitis media), middle ear effusion, and ear pain or tugging.

Procedure

Tympanocentesis is performed through piercing of the tympanic membrane and aspiration of the contents. This procedure is indicated in infants less than 6 weeks of age since AOM in this age group may be attributed to unusual organisms. Additionally, patients with failed treatment or signs indicative of sepsis should undergo this procedure. Finally, some patients will need a culture to determine the appropriate management, especially with the emergence of antibacterial resistance hindering treatment [4].

Imaging

Computed tomography (CT) or magnetic resonance imaging (MRI) are obtained if complications are suspected.

• Streptococcus Pneumoniae

  Prevalence rates of infections due to Streptococcus pneumoniae are declining due to widespread use of the Prevnar vaccine. Streptococcus pneumoniae is often resistant due to penicillin-binding protein alterations. [coreem.net]

  Abstract Streptococcus pneumoniae (Spn) is a common respiratory pathogen and a frequent cause of acute otitis media (AOM) in children. [ncbi.nlm.nih.gov]

Treatment Systematic reviews of antibiotic treatment conclude that there is only weak evidence that routine antibiotic treatment improves the course and outcomes of AOM. [ncbi.nlm.nih.gov]

Amoxicillin Clavulanate Potassium in the Treatment of Children with Acute Otitis Media with Effusion. [dx.doi.org]

Physicians should understand the etiology, pathophysiology, treatment options, and prognosis of facial palsy in association with otitis media. [ncbi.nlm.nih.gov]

Patients who have a bad prognosis in electrophysiological tests also have indication of surgery 3. [scielo.br]

With appropriate treatment Acute Ear Infection has excellent prognosis. [dovemed.com]

[…] activity or sleep) Reference: (1) MeReC Bulletin 2006;17(3):9-11. (2) Subcommittee on management of acute otitis media.Pediatrics 2004;113:1451-1465 Links: aetiology incidence infective organisms pathology clinical features management complications prognosis [gpnotebook.co.uk]

Multibacterial etiology was seen in 34 (38%) samples, and M. catarrhalis was detected in most (85%) of those cases. Fifteen signals for M. catarrhalis were strong, suggesting a highly probable etiological role of the pathogen. [ncbi.nlm.nih.gov]

Acute otitis media Summary Epidemiology Etiology Etiology Risk Factors for AOM Pathophysiology Clinical features Diagnostics Treatment Complications Intratemporal complications Intracranial complications [amboss.com]

BACKGROUND: Although acute otitis media (AOM) remains a major public health problem worldwide and brings economic burden on health care system and caregivers, little information is available about its epidemiology in Eastern Europe. [ncbi.nlm.nih.gov]

Epidemiology Highest incidence between 6–24 months of age Immunization of infants against pneumococci has decreased the incidence of AOM References:[1][2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Physicians should understand the etiology, pathophysiology, treatment options, and prognosis of facial palsy in association with otitis media. [ncbi.nlm.nih.gov]

Published on Jan 22, 2020 In this video, the viewer will learn the common risk factors and basic epidemiology, pathophysiology, recognize the clinical presentation and management as well as differentiate between acute otitis media, otitis media with effusion [youtube.com]

Acute otitis media Summary Epidemiology Etiology Etiology Risk Factors for AOM Pathophysiology Clinical features Diagnostics Treatment Complications Intratemporal complications Intracranial complications [amboss.com]

Pathophysiology: Obstruction to the eustachean tube seem to be the most important antecendent event in the pathophysiology of acute suppurative otitis media. [drtbalu.com]

There remains a need to develop improved vaccines for prevention of NTHi disease, which could be achieved by combining protein D with other antigens. [ncbi.nlm.nih.gov]

Prevention Taking care to prevent the spread of colds or the flu in the home and community can help prevent some cases of otitis media. [ada.com]

1. Paradise JL, Rockette HE, Colborn DK, et al. Otitis media in 2253 Pittsburgh-area infants: prevalence and risk factors during the first two years of life. Pediatrics. 1997; 99(3):318-33.
2. McDonald S, Langton Hewer CD, et al. Grommets (ventilation tubes) for recurrent acute otitis media in children. Cochrane Database of Systemic Reviews. 2008; (4):CD004741.
3. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013; 131(3):e964-99.
4. Block SL. Causative pathogens, antibiotic resistance and therapeutic considerations in acute otitis media. The Pediatric Infectious Disease Journal. 1997; 16(4):449-56.