otitis media (acute suppurative)

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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.


  • 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)


Last edited 04/2021