Overview

Acute otitis media (AOM) is a rapid-onset bacterial or viral infection of the middle ear, characterised by middle-ear effusion and signs of acute local or systemic illness. It is one of the most common diagnoses in paediatric primary care.

Presentation

Typical presentation includes otalgia (ear pain), fever, irritability in young children, and conductive hearing loss. Otorrhoea (discharge) indicates tympanic membrane perforation. Onset is usually within 48 hours.

Examination

Otoscopy is the primary examination. Classic findings include an erythematous, bulging tympanic membrane with loss of the light reflex and absent or reduced mobility on pneumatic otoscopy. Perforation with purulent discharge may be present in severe cases.

Management

Management follows a stratified approach: watchful waiting for mild cases in children over 2 years; first-line oral amoxicillin (high-dose) for confirmed cases or high-risk patients; analgesia with paracetamol or ibuprofen throughout. Persistent middle-ear effusion beyond 3 months warrants further assessment and possible myringotomy with ventilation tube insertion.

Nareseal EMR

Document this workup, examination findings, and management plan with Nareseal EMR.

Book a Demo

Acute otitis media remains a significant cause of morbidity in the paediatric population globally. Early diagnosis and appropriate management prevent complications including mastoiditis, meningitis, and chronic suppurative otitis media.

Risk factors

Age 6–24 months (anatomical Eustachian tube angle)
Attendance at group childcare
Passive smoke exposure
Bottle-feeding in supine position
Prior episode of AOM or family history

Complications to consider

Tympanic membrane perforation — common, usually self-healing
Chronic suppurative otitis media (CSOM) — persistent discharge through perforation
Mastoiditis — surgical emergency; look for post-auricular swelling and displaced pinna
Intracranial extension — rare but serious; meningitis, epidural abscess

Surgical intervention

When recurrent AOM or persistent middle-ear effusion warrants surgical assessment, instruments including the Micro Ear Cup Forceps are used intra-operatively to manage tympanic membrane pathology during myringoplasty or tympanoplasty.

Free Resource

Download the free ENT Instrument Reference (PDF)

A complete reference guide for clinical and surgical practice. Free, no spam.

Acute Otitis Media