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Otitis media

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Otitis media

  • is an inflammation of the middle ear, sometimes associated with upper respiratory tract infection.
  • it can be classified as follows:
    • acute suppurative
    • chronic suppurative
    • serous / secretory

  • acute suppurative otitis media
    • may be caused by viral or bacterial infections, or bacterial infection complicating a viral illness,
    • it causes ear pain and tenderness

  • chronic suppurative otitis media conditions are not usually painful

    • manifests as persistent drainage from the ear associated with tympanic membrane perforation and some degree of conductive hearing loss. Chronic ear
  • serous or secretory otitis media
    • refers to non-suppurative fluid accumulation in the middle ear
    • this condition is frequently associated with dysfunction or obstruction of the eustachian tube, such as may result from tonsillar hyperplasia or recurrent infection
    • this condition is an important cause of hearing problems in children.
    • in adults, a unilateral serous effusion may be due to a nasopharyngeal tumour which should be excluded

A review concluded that (1):

  • suspect acute otitis media in children with ear pain (ear symptoms can be subtle especially in young pre-verbal children), with or without fever

  • the presence of middle ear effusion on otoscopy is a prerequisite for diagnosis of acute otitis media

  • antibiotic treatment
    • offer oral antibiotics to children with acute otitis media who are systemically unwell and to those at high risk of complications because of pre-existing comorbidity
    • oral antibiotics can be considered in children under 2 with bilateral acute otitis media and in children of any age with acute otitis media and acute ear discharge a spontaneous rupture of the eardrum


  • Venekamp RA et al. Acute otitis media in children.BMJ 2020;371:m4238

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