Acute otitis media (AOM) is an infection of the middle ear. It is also known as purulent otitis media or suppurative otitis media. It is a common disease in children.
A viral upper airway infection, leading to oedema in the mucosa of the nose, nasopharynx and Eustachian tube, usually precedes AOM. Obstruction causes poor ventilation of the middle ear with the accumulation of secretions. Colonising bacteria and viruses can lead to suppuration. A building pressure in the middle ear causes pain, hearing loss, and may eventually cause the tympanic membrane to rupture, resulting in otorrhea. The most common bacterial pathogens causing AOM are Streptococcus pneumoniae and Haemophilus influenzae. In the large majority of cases, acute signs and symptoms resolve without active treatment within three days. Complications such as mastoiditis and facial nerve palsy occur seldomly.
In young children, especially those under one year old, AOM may present aspecifically, with fever, general irritability or disturbed sleep and feeding. AOM is often accompanied with symptoms of an upper airway infection. Acute otorrhoea in children with tympanic tubes is also considered an AOM.
Physical examination includes otoscopy, showing a bulging and / or erythematous tympanic membrane. Fluid in the middle ear results in an opaque tympanic membrane. A perforation or purulent material may be visible in a membrane rupture.
The diagnosis can be made if there is acute ear pain and / or illness (e.g. fever) in combination with (1) a red, bulging, and / or opaque tympanic membrane, or (2) a marked leftright difference in redness of the tympanic membrane, or (3) briefly existing otorrhoea.
Because of the generally favourable course of AOM, treatment in the Netherlands is focused on symptom relief with analgesics. Antibiotics are advised only for severely ill children and, for children at a higher risk of complications, such as those under six months old, immunocompromised children and children with craniofacial anatomic abnormalities.