Acute otitis media is a bacterial or viral infection of the middle ear, often after a cold, and is most common in young children. Fluid and pus build up behind the eardrum and cause pain and fever.
Key symptoms
- Ear pain, or tugging at the ear in young children
- Fever, irritability and poor sleep
- Reduced hearing on the affected side
- Ear discharge if the eardrum ruptures
What you find on exam
- Otoscopy: bulging, red or cloudy eardrum
- Reduced eardrum movement on pneumatic otoscopy
- Discharge in the ear canal if perforated
- Check behind the ear for swelling or tenderness (mastoiditis)
Tests
- Diagnosis is clinical, based on a bulging eardrum
- Pneumatic otoscopy or tympanometry to confirm middle ear fluid
- Hearing test if fluid lasts 3 months or more
- CT only if a complication such as mastoiditis is suspected
Treatment basics
- Pain relief with acetaminophen or ibuprofen
- High-dose amoxicillin (80 to 90 mg/kg/day) as first choice
- Watchful waiting for 48 to 72 hours in selected children with mild illness
- Amoxicillin-clavulanate if amoxicillin in the last 30 days or treatment fails
- Ear tubes for frequent recurrent infections
Red flags
- Swelling, redness or a pushed-forward ear (mastoiditis)
- Facial weakness, severe headache or stiff neck
- Infant under 6 months with high fever or looking very ill
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.