What is acute otitis media?
Acute otitis media (AOM) is an acute infection of the middle ear, accompanied by the accumulation of infected fluid (pus) behind the eardrum. It is one of the most common causes of pain in infants and young children, and represents the primary indication for antibiotic prescriptions in pediatrics.
Over 80% of children will have at least one episode of acute otitis media before the age of 3. Peak incidence occurs between 6 and 24 months.
Symptoms
- Intense otalgia — acute, pulsating ear pain; the infant cries, becomes restless, and pulls at their ear
- Fever — usually 38-40°C
- Irritability and crying — especially when lying down (pressure increases in the ear)
- Hearing loss — the child does not hear well in the affected ear
- Otorrhea — purulent discharge from the ear, if the eardrum has perforated (pain suddenly improves)
- Feeding refusal — in infants, due to pain during sucking and swallowing
- Sleep disturbances — frequent awakenings, nighttime crying
- Associated cold symptoms — rhinorrhea, cough, nasal congestion
In infants, symptoms may be nonspecific: isolated fever, irritability, vomiting, or diarrhea.
Causes
Acute otitis media usually occurs as a complication of an upper respiratory tract infection:
- Main bacterial agents — Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
- Viral infections — respiratory syncytial virus, rhinoviruses, adenoviruses (often precede bacterial superinfection)
- Eustachian tube dysfunction — in children, the tube is shorter, more horizontal, and wider, facilitating the ascent of germs from the nasopharynx
Risk factors
- Age between 6 and 24 months
- Attendance at group childcare (daycare)
- Hypertrophic adenoid vegetations
- Exposure to cigarette smoke
- Bottle feeding in the lying position
- Cold season (October-April)
- Associated allergic rhinitis
Diagnosis
- Otoscopy — bulging, hyperemic (red) eardrum with loss of the light reflex; sometimes an air-fluid level or perforation with otorrhea
- Otomicroscopy — detailed examination of the eardrum with a microscope
- Tympanometry — type B (flat) or type C (negative pressure) curve
- Otorrhea culture — in children with perforation or who do not respond to treatment
The diagnosis of acute otitis media is based on otoscopy: a bulging, hyperemic eardrum with effusion is the essential criterion. Simple tympanic hyperemia in a crying child does not confirm the diagnosis.
Treatment
Symptomatic treatment (in all cases)
- Analgesics-antipyretics — paracetamol or ibuprofen, doses according to weight
- Saline nasal washes — to relieve associated nasal congestion
Antibiotic therapy
- Immediate indication — children under 6 months, children with bilateral otitis under 2 years, severe forms (fever over 39°C, intense otalgia), otorrhea, children with risk factors
- Amoxicillin — first-line treatment, 80-90 mg/kg/day, 7-10 days
- Amoxicillin-clavulanate — when amoxicillin fails or in case of early recurrence
- Macrolides — for patients allergic to penicillin
- Watchful waiting — an option for children over 2 years with mild, unilateral forms, with reassessment at 48-72 hours
Surgical treatment
For children with recurrent acute otitis media (3 or more episodes in 6 months, or 4 in 12 months), the following may be indicated:
When to see a doctor
- Ear pain in an infant or young child
- Fever persists beyond 48 hours of antibiotic treatment
- Ear discharge (otorrhea) appears
- The child becomes drowsy or very irritable
- Swelling or redness behind the ear (sign of mastoiditis)
- Frequent episodes of acute otitis media or persistent hearing loss
Complications
- Acute mastoiditis — infection of the mastoid bone, a surgical emergency (retroauricular swelling, anteriorly displaced auricle)
- Tympanic perforation — usually heals spontaneously, but may become chronic
- Serous otitis — residual fluid in the middle ear after the acute episode
- Hearing loss — conductive (temporary) or sensorineural (rare)
- Facial paralysis — rare complication, due to facial nerve involvement
- Otogenic meningitis — rare but serious intracranial complication
- Cholesteatoma — in chronic forms with marginal perforations
Suspect acute otitis media in children? Schedule a consultation for diagnosis and a personalized treatment plan.