Acute otitis media - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Acute otitis media (AOM) may present with otalgia, irritability, decreased hearing, anorexia, vomiting, or fever, usually in the presence of an ongoing viral respiratory infection.
Physical examination will reveal a bulging, opacified tympanic membrane with an attenuated light reflex. The membrane may be white, yellow, pink, or red.
Diagnosis is generally made with conventional otoscopy.
Treatment includes pain control with analgesics and might include antibiotics.
Complications include otitis media with effusion, perforation of the tympanic membrane and, rarely, mastoiditis.

Otoscopy appearance of a bulging, erythematous tympanic membrane and absent landmarks

From the personal collection of Dr Armengol

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Definition

Epidemiology

Etiology

Pathophysiology

Images

Otoscopy appearance of a bulging, erythematous tympanic membrane and absent landmarks
Purulent otorrhea, indicating that the tympanic membrane has ruptured
Tympanic membrane with shagrination
Normal tympanic membrane, appearing draped over the umbo centrally, and the lateral process of the malleus in the anterosuperior quadrant. LM = lateral process of the malleus; I = incus; U = umbo; LR = light reflex; A = annulus of tympanic membrane; PI = posterior inferior quadrant
Purulent middle ear effusion and tympanic membrane with a loss of landmarks and characteristic bagel or doughnut appearance
Otoscopy of myringitis, showing erythema and injection of the tympanic membrane in the neutral position
Otoscopy of otitis media with effusion, showing air fluid levels or bubbles, with normal tympanic membrane landmarks
An image of previous patient's normal appearing tympanic membrane before the development of myringitis is provided for comparison
Otoscopic appearance of cholesteatoma
Otoscopic appearance of bullous myringitis
Otoscopic appearance of chronically perforated tympanic membrane

Citations

Key Articles

Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013 Mar;131(3):e964-99. [Erratum in: Pediatrics. 2014 Feb;133(2):346.][Abstract][Full Text]
Sjoukes A, Venekamp RP, van de Pol AC, et al. Paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs, alone or combined, for pain relief in acute otitis media in children. Cochrane Database Syst Rev. 2016 Dec 15;(12):CD011534.[Abstract][Full Text]

Referenced Articles

1. Teele DW, Klein JO, Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. J Infect Dis. 1989 Jul;160(1):83-94.[Abstract]
2. 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 Mar;99(3):318-33.[Abstract]
3. Stool SE, Randall P. Unexpected ear disease in infants with cleft palate. Cleft Palate J. 1967 Apr;4:99-103.[Abstract][Full Text]
4. Uhari M, Mantysaari K, Niemela M. A meta-analytic review of the risk factors for acute otitis media. Clin Infect Dis. 1996 Jun;22(6):1079-83.[Abstract][Full Text]
5. Klein JO. Otitis media. Clin Infect Dis. 1994 Nov;19(5):823-33.[Abstract]
6. Heikkinen T, Chonmaitree T. Importance of respiratory viruses in acute otitis media. Clin Microbiol Rev. 2003 Apr;16(2):230-41.[Abstract][Full Text]
7. Heikkinen T, Thint M, Chonmaitree T. Prevalence of various respiratory viruses in the middle ear during acute otitis media. N Engl J Med. 1999 Jan 28;340(4):260-4.[Abstract][Full Text]
8. Pitkaranta A, Virolainen A, Jero J, et al. Detection of rhinovirus, respiratory syncytial virus, and coronavirus infections in acute otitis media by reverse transcriptase polymerase chain reaction. Pediatrics. 1998 Aug;102(2 Pt 1):291-5.[Abstract]
9. Sanyal MA, Henderson FW, Stempel EC, et al. Effect of upper respiratory tract infection on eustachian tube ventilatory function in the preschool child. J Pediatr. 1980 Jul;97(1):11-5.[Abstract]
10. Winther B, Hayden FG, Arruda E, et al. Viral respiratory infection in schoolchildren: effects on middle ear pressure. Pediatrics. 2002 May;109(5):826-32.[Abstract]
11. Gehanno P, Lenoir G, Barry B, et al. Evaluation of nasopharyngeal cultures for bacteriologic assessment of acute otitis media in children. Pediatr Infect Dis J. 1996 Apr;15(4):329-32.[Abstract]
12. Worrall G. Acute otitis media. Can Fam Physician. 2007 Dec;53(12):2147-8.[Abstract][Full Text]
13. Kero P, Piekkala P. Factors affecting the occurrence of acute otitis media during the first year of life. Acta Paediatr Scand. 1987 Jul;76(4):618-23.[Abstract]
14. Casselbrant ML, Mandel EM, Kurs-Lasky M, et al. Otitis media in a population of black American and white American infants, 0-2 years of age. Int J Pediatr Otorhinolaryngol. 1995 Aug;33(1):1-16.[Abstract]
15. van Ingen G, le Clercq CMP, Touw CE, et al. Environmental determinants associated with acute otitis media in children: a longitudinal study. Pediatr Res. 2020 Jan;87(1):163-8.[Abstract]
16. Casselbrant ML, Mandel EM, Fall PA, et al. The heritability of otitis media: a twin and triplet study. JAMA. 1999 Dec 8;282(22):2125-30.[Abstract][Full Text]
17. Curns AT, Holman RC, Shay DK, et al. Outpatient and hospital visits associated with otitis media among American Indian and Alaska Native children younger than 5 years. Pediatrics. 2002 Mar;109(3):E41-1.[Abstract]
18. Niemela M, Pihakari O, Pokka T, et al. Pacifier as a risk factor for acute otitis media: a randomized, controlled trial of parental counseling. Pediatrics. 2000 Sep;106(3):483-8.[Abstract]
19. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013 Mar;131(3):e964-99. [Erratum in: Pediatrics. 2014 Feb;133(2):346.][Abstract][Full Text]
20. Culpepper L, Froom J, Bartelds AI, et al. Acute otitis media in adults: a report from the International Primary Care Network. J Am Board Fam Pract. 1993 Jul-Aug;6(4):333-9.[Abstract]
21. Halsted C, Lepow ML, Balassanian H, et al. Otitis media. Clinical observations, microbiology, and evaluation of therapy. Am J Dis Child. 1968 May;115(5):542-51.[Abstract]
22. Shaikh N, Hoberman A, Rockette HE, et al. Development of an algorithm for the diagnosis of otitis media. Acad Pediatr. 2012 May-Jun;12(3):214-8.[Abstract]
23. Schwartz RH, Stool SE, Rodriguez WJ, et al. Acute otitis media: toward a more precise definition. Clin Pediatr (Phila). 1981 Sep;20(9):549-54.[Abstract]
24. Hayden GF, Schwartz RH. Characteristics of earache among children with acute otitis media. Am J Dis Child. 1985 Jul;139(7):721-3.[Abstract]
25. Armengol CE, Hendley JO, Winther B. Occurrence of acute otitis media during colds in children younger than four years. Pediatr Infect Dis J. 2011 Jun;30(6):518-20.[Abstract]
26. Le Saux N, Robinson JL; Canadian Paediatric Society, Infectious Diseases and Immunization Committee. Management of acute otitis media in children six months of age and older. Paediatr Child Health. 2016 Jan-Feb;21(1):39-50.[Abstract][Full Text]
27. Sjoukes A, Venekamp RP, van de Pol AC, et al. Paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs, alone or combined, for pain relief in acute otitis media in children. Cochrane Database Syst Rev. 2016 Dec 15;(12):CD011534.[Abstract][Full Text]
28. Chonmaitree T, Saeed K, Uchida T, et al. A randomized, placebo-controlled trial of the effect of antihistamine or corticosteroid treatment in acute otitis media. J Pediatr. 2003 Sep;143(3):377-85.[Abstract]
29. Hum SW, Shaikh KJ, Musa SS, et al. Adverse events of antibiotics used to treat acute otitis media in children: a systematic meta-analysis. J Pediatr. 2019 Dec;215:139-43;e7.[Abstract]
30. Mather MW, Drinnan M, Perry JD, et al. A systematic review and meta-analysis of antimicrobial resistance in paediatric acute otitis media. Int J Pediatr Otorhinolaryngol. 2019 Aug;123:102-9.[Abstract]
31. Vouloumanou EK, Karageorgopoulos DE, Kazantzi MS, et al. Antibiotics versus placebo or watchful waiting for acute otitis media: a meta-analysis of randomized controlled trials. J Antimicrob Chemother. 2009 Jul;64(1):16-24.[Abstract]
32. Tähtinen PA, Laine MK, Huovinen P, et al. A placebo-controlled trial of antimicrobial treatment for acute otitis media. N Engl J Med. 2011 Jan 13;364(2):116-26.[Abstract][Full Text]
33. Hoberman A, Paradise JL, Rockette HE, et al. Treatment of acute otitis media in children under 2 years of age. N Engl J Med. 2011 Jan 13;364(2):105-15.[Abstract][Full Text]
34. Venekamp RP, Sanders SL, Glasziou PP, et al. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev. 2015 Jun 23;(6):CD000219.[Abstract][Full Text]
35. Rosenfeld RM, Vertrees JE, Carr J, et al. Clinical efficacy of antimicrobial drugs for acute otitis media: metaanalysis of 5400 children from thirty-three randomized trials. J Pediatr. 1994 Mar;124(3):355-67.[Abstract]
36. Courter JD, Baker WL, Nowak KS, et al. Increased clinical failures when treating acute otitis media with macrolides: a meta-analysis. Ann Pharmacother. 2010 Mar;44(3):471-8.[Abstract]
37. Casey JR, Block SL, Hedrick J, et al. Comparison of amoxicillin/clavulanic acid high dose with cefdinir in the treatment of acute otitis media. Drugs. 2012 Oct 22;72(15):1991-7.[Abstract][Full Text]
38. Cohen R, Levy C, Boucherat M, et al. A multicenter, randomized, double-blind trial of 5 versus 10 days of antibiotic therapy for acute otitis media in young children. J Pediatr. 1998 Nov;133(5):634-9.[Abstract]
39. Hoberman A, Paradise JL, Rockette HE, et al. Shortened antimicrobial treatment for acute otitis media in young children. N Engl J Med. 2016 Dec 22;375(25):2446-56.[Abstract][Full Text]
40. Little P, Gould C, Williamson I, et al. Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media. BMJ. 2001 Feb 10;322(7282):336-42.[Abstract][Full Text]
41. Spiro DM, Tay KY, Arnold DH, et al. Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. JAMA. 2006 Sep 13;296(10):1235-41.[Abstract][Full Text]
42. Siegel RM, Kiely M, Bien JP, et al. Treatment of otitis media with observation and a safety-net antibiotic prescription. Pediatrics. 2003 Sep;112(3 pt 1):527-31.[Abstract]
43. Rovers MM, Glasziou P, Appelman CL, et al. Predictors of pain and/or fever at 3 to 7 days for children with acute otitis media not treated initially with antibiotics: a meta-analysis of individual patient data. Pediatrics. 2007 Mar;119(3):579-85.[Abstract]
44. Tähtinen PA, Laine MK, Ruohola A. Prognostic factors for treatment failure in acute otitis media. Pediatrics. 2017 Sep;140(3):e20170072.[Abstract]
45. Sun D, McCarthy TJ, Liberman DB. Cost-effectiveness of watchful waiting in acute otitis media. Pediatrics. 2017 Apr;139(4):e20163086.[Abstract]
46. Bluestone CD. Role of surgery for otitis media in the era of resistant bacteria. Pediatr Infect Dis J. 1998 Nov;17(11):1090-8.[Abstract]
47. Block SL. Tympanocentesis: why, when and how. Contemp Pediatr. 1999;16:103-27.
48. Bertin L, Pons G, d'Athis P, et al. A randomized, double-blind, multicentre controlled trial of ibuprofen versus acetaminophen and placebo for symptoms of acute otitis media in children. Fundam Clin Pharmacol. 1996;10(4):387-92.[Abstract]
49. US Food and Drug Administration. FDA news release: FDA takes action against unapproved prescription ear drop products. July 2015 [internet publication].[Full Text]
50. Arguedas A, Soley C, Kamicker BJ, et al. Single-dose extended-release azithromycin versus a 10-day regimen of amoxicillin/clavulanate for the treatment of children with acute otitis media. Int J Infect Dis. 2011 Apr;15(4):e240-8.[Abstract]
51. Scott AM, Clark J, Julien B, et al. Probiotics for preventing acute otitis media in children. Cochrane Database Syst Rev. 2019 Jun 18;6:CD012941.[Abstract][Full Text]
52. Marchisio P, Santagati M, Scillato M, et al. Streptococcus salivarius 24SMB administered by nasal spray for the prevention of acute otitis media in otitis-prone children. Eur J Clin Microbiol Infect Dis. 2015 Dec;34(12):2377-83.[Abstract]
53. National Institute for Health and Care Excellence (UK). Otitis media (acute): antimicrobial prescribing. Mar 2022 [internet publication].[Full Text]
54. Rosenfeld RM, Tunkel DE, Schwartz SR, et al. Clinical practice guideline: tympanostomy tubes in children (update). Otolaryngol Head Neck Surg. 2022 Feb;166(1_suppl):S1-S55.[Abstract][Full Text]
55. Bluestone CD. Clinical course, complications and sequelae of acute otitis media. Pediatr Infect Dis J. 2000 May;19(5 suppl):S37-46.[Abstract]
56. Koopman L, Hoes AW, Glasziou PP, et al. Antibiotic therapy to prevent the development of asymptomatic middle ear effusion in children with acute otitis media: a meta-analysis of individual patient data. Arch Otolaryngol Head Neck Surg. 2008 Feb;134(2):128-32.[Abstract][Full Text]
57. Rault P, Chabrier A, Roy H, et al. Assessment of adherence to at-home oral anti-infective therapy among paediatric patients discharged from a Quebec hospital. Eur J Hosp Pharm. 2023 Jan;30(1):35-40.[Abstract]
58. Bowatte G, Tham R, Allen KJ, et al. Breastfeeding and childhood acute otitis media: a systematic review and meta-analysis. Acta Paediatr. 2015 Dec;104(467):85-95. [Abstract][Full Text]
59. Marchisio P, Bortone B, Ciarcià M, et al. Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics: Prevention. Pediatr Infect Dis J. 2019 Dec;38(12s suppl):S22-S36.[Abstract][Full Text]
60. de Sévaux JL, Venekamp RP, Lutje V, et al. Pneumococcal conjugate vaccines for preventing acute otitis media in children. Cochrane Database Syst Rev. 2020 Nov 24;11:CD001480.[Abstract][Full Text]
61. Pichichero M, Kaur R, Scott DA, et al. Effectiveness of 13-valent pneumococcal conjugate vaccination for protection against acute otitis media caused by Streptococcus pneumoniae in healthy young children: a prospective observational study. Lancet Child Adolesc Health. 2018 Aug;2(8):561-8.[Abstract]
62. Kobayashi M, Farrar JL, Gierke R, et al. Use of 15-valent pneumococcal conjugate vaccine among U.S. children: updated recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep. 2022 Sep 16;71(37):1174-81.[Abstract][Full Text]
63. Norhayati MN, Ho JJ, Azman MY. Influenza vaccines for preventing acute otitis media in infants and children. Cochrane Database Syst Rev. 2017 Oct 17;(10):CD010089.[Abstract][Full Text]
64. Winther BB. Impact of oseltamivir treatment on the incidence and course of acute otitis media in children with influenza. Int J Pediatr Otorhinolaryngol. 2010 Jun;74(6):684-8.[Abstract]
65. Gibbs D. Oseltamivir effective for reducing influenza duration in children. Am Fam Physician. 2010 Nov 1;82(9):1140-1.[Full Text]
66. Tapiainen T, Luotonen L, Kontiokari T, et al. Xylitol administered only during respiratory infections failed to prevent acute otitis media. Pediatrics. 2002 Feb;109(2):E19.[Abstract]
67. Hautalahti O, Renko M, Tapiainen T, et al. Failure of xylitol given three times a day for preventing acute otitis media. Pediatr Infect Dis J. 2007 May;26(5):423-7.[Abstract]
68. Azarpazhooh A, Lawrence HP, Shah PS, et al. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database Syst Rev. 2016 Aug 3;(8):CD007095.[Abstract][Full Text]
69. Danhauer JL, Johnson CE, Corbin NE, et al. Xylitol as a prophylaxis for acute otitis media: systematic review. Int J Audiol. 2010 Oct;49(10):754-61.[Abstract]
70. Leach AJ, Morris PS. Antibiotics for the prevention of acute and chronic suppurative otitis media in children. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD004401.[Abstract][Full Text]