Acute Otitis Media

Acute otitis media is a sudden infection of the middle ear, most common in young children, often following an upper respiratory tract infection.

• Ear pain (in infants: pulling or rubbing the ear, irritability)
• Fever
• Reduced hearing or a feeling of fullness in the ear
• Ear discharge if the eardrum has ruptured
• Irritability and poor feeding in infants

• Most commonly caused by bacteria such as Streptococcus pneumoniae and Haemophilus influenzae, or by viruses.
• Usually follows or accompanies an upper respiratory tract infection, which causes swelling and blockage of the Eustachian tube.
• Risk is increased in young children, those with allergies, and exposure to tobacco smoke.

• Diagnosed by examining the eardrum (otoscopy), looking for redness, bulging, or fluid behind the eardrum.
• History of recent upper respiratory infection supports the diagnosis.
• Ear discharge, if present, suggests eardrum perforation.

Pain and fever are managed with paracetamol.

An oral antibiotic, with amoxicillin as first-line, is given for confirmed or likely bacterial acute otitis media, particularly in children under two years, those with severe symptoms, or ear discharge.

Cases that do not improve after treatment, or that involve recurrent infections, chronic discharge, or suspected complications (such as mastoiditis), are referred for further assessment.

• Complete routine childhood immunisation, including pneumococcal conjugate vaccine.
• Avoid exposure to tobacco smoke.
• Promote breastfeeding, which lowers the risk of ear infections.
• Seek prompt treatment for colds and upper respiratory infections in children.