Yes, acute otitis media (AOM) can cause vomiting in children, and this symptom is clinically significant.
Vomiting occurs in approximately 21-24% of children with AOM and is an important clinical marker that identifies children at higher risk for poor outcomes and those who benefit most from immediate antibiotic therapy 1, 2.
Clinical Significance of Vomiting in AOM
When vomiting accompanies AOM, it serves as a predictor of disease severity:
Children with fever OR vomiting at presentation are significantly more likely to experience distress and sleep disturbance by day 3 (adjusted odds ratio 2.6 for distress, 2.1 for night disturbance) 3
Immediate antibiotic treatment in children with vomiting reduces distress by day 3 from 53% to 32% (NNT=5) and night disturbance from 59% to 26% (NNT=3) 3
In contrast, children without fever or vomiting show minimal benefit from immediate antibiotics, with similar outcomes whether treated immediately or with delayed prescribing 4, 3
Treatment Algorithm Based on Vomiting Status
For children WITH vomiting (or fever ≥39°C):
- Prescribe immediate antibiotics - observation is not appropriate
- Use high-dose amoxicillin (80-90 mg/kg/day in 2 divided doses) as first-line 5, 1
- These children have proven benefit from immediate treatment with better symptom resolution
For children WITHOUT vomiting or high fever:
- Observation with close follow-up is a reasonable option, particularly in children ≥24 months with unilateral disease 5
- Shared decision-making with parents is appropriate
- These children often have spontaneous resolution
Common Pitfall
Do not dismiss vomiting as merely a gastrointestinal symptom unrelated to the ear infection. Vomiting in the context of AOM represents systemic illness severity and should trigger more aggressive management. The presence of vomiting alongside respiratory syncytial virus co-infection is particularly common 6.
The evidence consistently demonstrates that vomiting is both a common presenting symptom of AOM and a critical decision point for determining whether immediate antibiotic therapy versus observation is most appropriate for optimizing patient outcomes.