Can otitis media cause vomiting in an 18-month-old?

Can Otitis Media Cause Vomiting in an 18-Month-Old?

Yes, otitis media can cause vomiting in an 18-month-old child, though vomiting is a nonspecific symptom that does not reliably differentiate acute otitis media from upper respiratory tract infections.

Clinical Presentation of Otitis Media in Young Children

Vomiting is recognized as one of the nonspecific symptoms that can accompany acute otitis media (AOM) in young children 1. However, it's important to understand that:

• Vomiting, like fever, does not specifically differentiate children with AOM from those with upper respiratory tract infections (URTI) alone 1
• The most consistent symptom of AOM is ear pain, but only 50-60% of children with AOM actually complain of ear pain 1
• In preverbal children like 18-month-olds, ear pain may manifest as ear manipulation (tugging, rubbing, holding), excessive crying, or changes in sleep and behavior patterns 1

Why Vomiting Occurs with Otitis Media

The mechanism relates to the systemic inflammatory response and the connection between the middle ear and vestibular system:

• Typical signs and symptoms of AOM include ear pain, fever, irritability, otorrhea, anorexia, and sometimes vomiting or lethargy 2
• The presence of vomiting suggests a more systemic response to the infection 3

Diagnostic Approach

When evaluating an 18-month-old with vomiting, you should:

• Perform pneumatic otoscopy to assess for middle ear effusion and tympanic membrane bulging 1
• Look for moderate to severe bulging of the tympanic membrane or new-onset otorrhea not caused by otitis externa 2
• Assess for mild bulging combined with recent-onset ear pain (less than 48 hours) or intense erythema of the tympanic membrane 2
• Recognize that signs may be subtle in young children, and typical symptoms might be absent 1

Important Clinical Context

Do not assume vomiting alone indicates AOM—it requires proper otoscopic confirmation 1. The vomiting could be:

• Part of a concurrent viral URTI that also triggered the otitis media 4, 5
• Related to the systemic inflammatory response from AOM 3
• From an entirely separate gastrointestinal process

Common Pitfalls to Avoid

• Assuming all symptoms are from viral infection when bacterial AOM may have developed 4
• Diagnosing AOM based on nonspecific symptoms alone without proper otoscopic examination 1
• Missing the diagnosis because the child cannot verbalize ear pain 1