Acute otitis media (AOM)
Acute otitis media is acute infection/inflammation of the middle ear, most commonly following a viral upper respiratory infection. It is very common in infancy and early childhood and is usually self‑limiting; symptoms typically last about 3 days and most resolve within 1 week (NICE NG91).
Emergency department (ED) priorities are recognising red flags and complications, providing effective analgesia, practising appropriate antibiotic stewardship (immediate vs delayed vs none) and giving clear safety‑netting.
Pathogens and pathophysiology
- AOM commonly follows nasopharyngeal viral infection with secondary eustachian tube dysfunction and middle‑ear effusion; bacterial superinfection is frequent and viral-bacterial co‑infection is common.
- Common viral pathogens: RSV, rhinovirus, adenovirus, influenza, parainfluenza.
- Common bacterial pathogens: Streptococcus pneumoniae, non‑typeable Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes.
Clinical presentation
- Otalgia is typical; preverbal children present with irritability, disturbed sleep, ear‑pulling and reduced feeding.
- Other features: fever, reduced hearing or aural fullness, headache, nausea/vomiting.
- Otoscopy: bulging, erythematous tympanic membrane (TM) with reduced mobility on pneumatic otoscopy; loss of landmarks.
- Otorrhoea indicates tympanic membrane perforation or discharge from the external canal.
- In infants systemic features (poor feeding, lethargy, high fever) may predominate.