From the Guidelines
Acute Otitis Media (AOM) is characterized by signs and symptoms including ear pain, fever, hearing loss, and a sensation of fullness in the affected ear, with the tympanic membrane appearing red, bulging, and having limited mobility on pneumatic otoscopy, as noted in the study published in Nature Reviews Disease Primers 1. The most common symptoms of AOM include:
- Ear pain (otalgia), which can be severe and is often the primary complaint, especially in children who may tug at their ears
- Fever, typically ranging from 100.4°F (38°C) to 104°F (40°C)
- Hearing loss or a sensation of fullness in the affected ear, occurring as fluid builds up behind the eardrum
- Irritability, crying, and sleep disturbances, particularly common in infants and young children who cannot verbalize their discomfort
- Drainage from the ear (otorrhea) may occur if the eardrum ruptures, often providing temporary pain relief These symptoms develop rapidly, often within 24-48 hours, and frequently follow an upper respiratory infection as bacteria or viruses travel from the nasopharynx to the middle ear through the Eustachian tube, as described in the study published in Pediatrics 1. The diagnosis of AOM depends on typical signs and symptoms, such as acute ear pain and bulging of the tympanic membrane, with diagnostic modalities including pneumatic otoscopy, tympanometry, and audiometry, as outlined in the study published in Nature Reviews Disease Primers 1. According to the study published in Pediatrics 1, the management of AOM includes symptomatic management of ear pain and fever, reserving antibiotics for children with severe, persistent, or recurrent infections. It is essential to note that the degree of bulging does not reflect AOM severity, and severe AOM is defined as having moderate-to-severe ear pain, ear pain for at least 48 hours, or a temperature of ≥39°C, as stated in the study published in Nature Reviews Disease Primers 1. In summary, AOM presents with distinct signs and symptoms, and its diagnosis and management should be guided by the most recent and highest-quality evidence, prioritizing the reduction of morbidity, mortality, and improvement of quality of life, as emphasized in the studies published in Nature Reviews Disease Primers 1 and Pediatrics 1.
From the Research
Signs and Symptoms of Acute Otitis Media (AOM)
- Acute onset of symptoms such as pain, irritability, or fever 2
- Middle ear effusion and physical evidence of middle ear inflammation 2
- Ear pain, fever, and discharge 3
- Hearing loss 3
- Otalgia, fever, and a bulging eardrum on otoscopy in adults 4
- Symptoms may include ear pain (rubbing, tugging, or holding the ear may be a sign of pain), fever, irritability, otorrhea, anorexia, and sometimes vomiting or lethargy in children 5
Common Causes of AOM
- Viral upper respiratory tract infections 2, 6
- Bacterial infections, with Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis being the most common organisms isolated from middle ear fluid 2, 6
- Eustachian tube dysfunction 2
Diagnosis and Treatment
- Diagnosis is based on symptoms, physical examination, and otoscopy 2, 5
- Treatment includes pain management and observation or antibiotics, depending on the patient's age, severity of symptoms, and whether the AOM is unilateral or bilateral 5
- High-dose amoxicillin is the first-line antibiotic therapy for AOM, unless the patient has taken amoxicillin for AOM in the previous 30 days or has concomitant purulent conjunctivitis 5