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

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

  Hearing symptoms were common (67%) but fever (32%) and retroauricular symptoms were uncommon in AOM. Fever (44%) and mastoid tenderness (65%) were common in AM. Patients with LM underwent the most mastoidectomies (54%). [ncbi.nlm.nih.gov]

  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]

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

  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]

• 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]

• Severe Abdominal Pain

  A female aged 9 years with a recent episode of acute otitis media (AOM) presented to her primary care physician with complaints of severe abdominal pain with right lower quadrant rebound tenderness, suggestive of an acute surgical abdomen. [ncbi.nlm.nih.gov]

• Otalgia

  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]

  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]

  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]

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

• Ear Discharge

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

  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]

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

• Tinnitus

  The limited evidence available suggests that acute otitis media with tinnitus and/or bacterial pathology may have an increased risk of sudden sensorineural hearing loss, which is consistent with the case described. [ncbi.nlm.nih.gov]

  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]

  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]

  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]

  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]

• Dizziness

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

  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]

  […] local policy Combination antibiotic and steroid ear drops Good analgesia IV fluids if the patient is vomiting or dehydrated Artificial tears and eye lubrication if there is facial palsy Short term vestibular sedative eg prochlorperazine if there is dizziness [entsho.com]

• 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]

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

  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]

  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]

• Febrile Seizures

  seizures Tender mastoid in late stages In older children Otalgia/earache, commonly with throbbing Hearing loss in the affected ear Fever Tender mastoid in late stages References:[1][2] Diagnostics Otoscopy: tympanic membrane (TM) evaluation Early findings [amboss.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.

Our primary outcome was time until treatment failure. RESULTS: Treatment failure occurred in 31.7% of all children. [ncbi.nlm.nih.gov]

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]

OBJECTIVES: To study the epidemiology of acute otitis media (AOM), especially the otitis-prone condition, during the pneumococcal conjugate vaccines 7 and 13 era. [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]

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

CONCLUSIONS: This is the first report of recurrent AOM prevention by herbal medication. JTT appears to effectively prevent recurrent AOM in children. [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. Children should not be exposed to second hand cigarette smoke. [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.