otitis media (acute suppurative)

Last edited 04/2021 and last reviewed 05/2021

Acute otitis media is an acute inflammation of the middle ear cavity. It is a common condition, occurring most frequently in children, and is often bilateral. Acute otitis media has a peak incidence of between 3 years and six years.

• acute otitis media
  • common causes are upper respiratory tract infections which may be viral or bacterial
  • clinical features associated with an increase in the likelihood of acute otitis media
    • ear pain
    • ear rubbing
    • cloudy eardrum
    • bulging eardrum
    • distinctly immobile eardrum
    • distinctly red eardrum
• 80% recover in around three days without antibiotics
• complications are rare
• a review concluded that antibiotics should not be prescribed routinely for acute otitis media in children (1)
  • antibiotic treatment reduces pain to a small degree but this should be balanced against the risk of causing adverse effects such as vomiting, diarrhoea or rashes
  • there may benefit for antibiotic treatment in specific sub-groups of patients. For example, children:
    • under two years with bilateral infection or
    • with discharge from the ear or
    • who are systemically unwell (e.g. fever or vomiting) or
    • with recurrent infections
  • a strategy of watchful waiting and use of delayed prescriptions may be appropriate for many
  • paracetamol and ibuprofen have been shown to reduce earache
  • insufficient evidence to support the use of decongestants or antihistamines.

Notes:

• a definition of acute otitis media (AOM) includes all of the following three elements (1):
  
  • 1) recent, abrupt, onset of signs and symptoms of middle-ear inflammation and middle-ear effusion
  • 2) the presence of middle-ear effusion (MEE) that is indicated by any of the following:
    • bulging of the tympanic membrane
    • limited or absent mobility of the tympanic membrane
    • air fluid level behind the tympanic membrane
    • otorrhoea
  • 3) signs or symptoms of middle-ear inflammation as indicated by either of the following:
    • distinct erythema of the tympanic membrane
      
    • distinct otalgia (discomfort clearly referable to the ear[s] that interferes with normal activity or sleep)
• acute otitis externa can mimic the appearance of acute otitis media (AOM) because of erythema involving the tympanic membrane (3)

Reference:

• (1) MeReC Bulletin 2006;17(3):9-11.
• (2) Subcommittee on management of acute otitis media.Pediatrics 2004;113:1451-1465
• (3) Rosenfeld RM, Schwartz SR, Cannon CR, et al. Clinical practice guideline: acute otitis externa.Otolaryngol Head Neck Surg2014;150(Suppl):S1-24.doi: 10.1177/0194599813517083