Overview
Definition
An acute bacterial or viral infection of the middle ear fluid.
Epidemiology
Extremely common in infants and young children (peak age 6-24 months) due to shorter, more horizontal Eustachian tubes.
Etiology & Risk Factors
- Streptococcus pneumoniae (most common)
- Haemophilus influenzae (non-typeable)
- Moraxella catarrhalis
Clinical Symptoms
- Otalgia (ear pain), often causing infants to tug or pull at their ears
- Fever, irritability, crying
- Hearing loss (conductive)
- Otorrhea (if the tympanic membrane ruptures)
Clinical Approach
Diagnosis
- Otoscopy: Bulging, erythematous, opacified Tympanic Membrane (TM) with loss of the normal light reflex and bony landmarks
- Pneumatic otoscopy (Gold Standard): Decreased or absent TM mobility
Management
- Pain control: Acetaminophen or Ibuprofen
- Antibiotics (High-dose Amoxicillin is first-line) for children < 2 years, or children with severe symptoms/bilateral disease
- Observation option (Watchful Waiting): Can be considered in children > 2 years with mild, unilateral symptoms for 48-72 hours
- Recurrent AOM: Tympanostomy tube placement (myringotomy)
Complications
- Tympanic membrane perforation
- Mastoiditis (infection spreads to the mastoid air cells, causing post-auricular erythema/swelling and forward displacement of the ear)
- Cholesteatoma