Clinical features

Acute otitis media is more common in children. Its symptoms and signs include: (1,2)

• symptoms
  • earache, usually throbbing and severe
  • young children unable to express their earache might be noted to frequently rub their ear
  • excessive crying
  • pyrexia up to 40 degrees - child may be flushed
  • otorrhoea will often be blood-stained - profuse and mucoid at first, later becomes thick and yellow
  • mucoid discharge: signifies tympanic membrane perforation, after which pain subsides
• signs
  • conductive deafness is always present, and may be accompanied by tinnitus
  • tympanic membrane signs depend on the stage of infection
    • loss of lustre
    • break-up of the light reflex
    • redness
    • impaired mobility of tympanic membrane
    • fullness of the ear drum - malleus handle becomes more vertical
    • progression to a bulging ear drum - purple colour
    • the final stage is perforation
  • tenderness: possibly to pressure on the mastoid antrum
• diagnostic tests include;
  • acoustic reflectometry
  • pneumatic otoscopy
  • portable tympanometry
  • professional tympanometry

Reference:

1. Jamal A et al. Etiology, Diagnosis, Complications, and Management of Acute Otitis Media in Children. Cureus. 2022 Aug 15;14(8)
2. Danishyar A. Acute Otitis Media. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. 2023 Apr 15.