Acute Otitis Media

Acute otitis media (AOM) is a suppurative infection of the middle ear cleft that usually follows a viral upper respiratory infection. Eustachian tube dysfunction traps fluid in the middle ear; inflammation and bacterial growth then increase pressure until the tympanic membrane becomes opaque and bulges. That pressure explains the abrupt otalgia, fever, and irritability. The diagnosis is not “a red eardrum plus fever.” Middle ear effusion must be present, demonstrated by reduced tympanic membrane mobility on pneumatic otoscopy or by tympanometry. Once AOM is confirmed, treatment depends on six features: the child’s age, unilateral versus bilateral disease, symptom severity and duration, otorrhea, recent amoxicillin exposure, and the presence of purulent conjunctivitis or penicillin allergy. Pain treatment is required whether antibiotics are prescribed immediately or observation is chosen.