Acute otitis media (AOM) is an infection of the middle ear fluid that is almost exclusively found in young children. It is usually caused by bacterial infections but can be viral as well. Streptococcus pneumoniae, non-typeable Haemophilus influenzae, and Moraxella catarrhalis are the most common bacterial causes. Respiratory syncytial virus (RSV) and viruses that cause the common cold are the most frequent viral etiologies.
Despite universal immunization of infants with pneumococcal vaccination, Spneumoniae still accounts for the most common bacterial isolate of AOM. Haemophilus influenzae type b (Hib) vaccination has had a minor impact on the incidence of AOM because the majority of cases of AOM are caused by non-typeable Hinfluenzae.
The first stage of AOM is characterized by redness and inflammation. As pressure builds up in the middle ear, the tympanic membrane bulges out until a pressure necrosis forms. The formation of the pressure necrosis allows for the eardrum to perforate and release the mucopurulent material into the external ear canal. A dramatic relief of pain and resolution of the disease usually follow shortly after discharge. This whole process can take 12 hours in virulent infections or a few days in more mild infections.
Symptoms – Children may be easily irritable with fever, earache, and a feeling of aural fullness due to inflammation. As the middle ear fills with pus, the pain increases and hearing decreases. Children with AOM may present with ear discharge (otorrhea) as the only symptom.
Signs – Redness of tympanic membrane and swelling of upper portion (pars flaccida). The tympanic membrane may bulge laterally as the disease progresses to eventually form a pressure necrosis of the drum.
H influenzae usually causes bilateral AOM, while Spneumoniae does not have this propensity.
Younger children are more susceptible to AOM due to anatomical defects or immunologic deficiencies. Eustachian tube dysfunction is the most common anatomical abnormality causing ineffective clearing of bacteria from the middle ear and leading to increased susceptibility. Children with primary humoral immune deficiency (especially immunoglobulin G [IgG] subclasses) or HIV infection are prone to recurrent AOM as part of the spectrum of clinical manifestations.
Immunocompromised Patient Considerations: AOM may present with systemic sepsis and purulent ear discharge instead of more classic signs and symptoms.
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
Acute otitis media is a middle ear infection commonly seen in young children (6 months to 2 years old). It may also affect older children and adults, although not as frequently. Middle ear infection is usually bacterial, but sometimes viral, and can cause ear pain, redness, bulging of the tympanic membrane (eardrum), and fluid discharge from the ear. It can also cause temporary hearing loss. The infection can last up to a week or longer before subsiding.
Who’s At Risk
Young children are most at risk of acute otitis media, especially if they have a history of ear infections.
Otitis media often follows an upper respiratory infection. Children in preschool and day care facilities commonly exposed to illness are often at risk of contracting ear infections. They are more common in the winter.
Signs & Symptoms
Acute otitis media presents as:
Bulging of the tympanic membrane
It may be accompanied by:
A feeling of fullness in the ear
Rupture of the eardrum
Discharge of pus from the outer ear
Other symptoms of middle ear infection are:
Poor feeding or lack of appetite
The child may be given over-the-counter pain medication (Tylenol or ibuprofen), but NOT aspirin (which can cause dangerous Reye syndrome).
When to Seek Medical Care
Fever, severe ear pain, and ear discharge are strong clues to contact your child's health care provider. Following a doctor visit, if symptoms fail to subside, or if they worsen, contact your doctor again to avoid complications and irreversible hearing damage.
Your doctor may recommend over-the-counter pain medications, but not usually cold or cough medicine. Your doctor will prescribe an antibiotic if the infection is bacterial. However, most middle ear infections are viral.