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Acute otitis media



AOM is defined as an infection of the middle ear space.
AOM is mostly caused by bacteria (S. pneumoniae, H. influenzae, M. catarrhalis) followed by viruses.
Disease course
The inflammatory disease due to middle ear space infection with particular involvement of the tympanic membrane results in AOM, which presents with clinical presentations of earache, otorrhea, headache, fever, general malaise, and hearing impairment. AOM is a self-limiting condition.
Prognosis and risk of recurrence
AOM is not associated with an increase in mortality.


Key sources

The following summarized guidelines for the evaluation and management of acute otitis media are prepared by our editorial team based on guidelines from the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF 2022), the Italian Society of Pediatrics (ISP 2019), the Danish Society of Otorhinolaryngology, Head and Neck Surgery (DSOHH/DHMA 2016), and the American Academy of Pediatrics (AAP/AAFP 2013)....
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Screening and diagnosis

Diagnostic criteria: as per ISP 2019 guidelines, View the sole presence of otorrhea, not secondary to external otitis, associated with spontaneous perforation of the tympanic membrane as a certain objective sign of AOM.
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Diagnostic investigations

Clinical assessment: as per AAO-HNSF 2022 guidelines, Assess whether the pediatric patient with recurrent otitis media with effusion of any duration is at increased risk for speech, language, or learning problems from otitis media because of baseline sensory, physical, cognitive, or behavioral factors.

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  • Tympanic membrane assessment

Medical management

As per ISP 2019 guidelines:
Prioritize assessment and treatment of otalgia in patients with AOM. Administer adequate doses of ibuprofen or acetaminophen.
Do not use topical analgesic drops or analgesic preparations based on natural extracts due to the lack of available high-quality evidence.

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  • Systemic antibiotics (indications, young children)

  • Systemic antibiotics (indications, older children)

  • Systemic antibiotics (regimens)

  • Topical antibiotics

  • Decongestants

  • Corticosteroids

Nonpharmacologic interventions

Nasal irrigation: as per ISP 2019 guidelines, Consider performing nasal lavage to remove nasal secretions as a complementary therapeutic measure.

Therapeutic procedures

Cerumen removal: as per ISP 2019 guidelines, Consider removing the cerumen from the external auditory canal, performed by an appropriately trained pediatrician or by an otolaryngologist, with various operational and organizational methods depending on the care setting, the level of the practitioner's expertise, and the instruments available.

Surgical interventions

Tympanostomy: as per AAO-HNSF 2022 guidelines, Offer bilateral tympanostomy tube insertion in pediatric patients with recurrent AOM with unilateral or bilateral middle ear effusion at the time of assessment for tube candidacy.
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  • Adenoidectomy

Patient education

Assessment of treatment response: as per AAFP/AAP 2013 guidelines, Reassess patients in whom symptoms worsen or fail to respond to initial antibiotic treatment within 48-72 hours, and determine whether a change in therapy is needed.

Preventative measures

Routine immunizations
As per AAFP/AAP 2013 guidelines:
Provide influenza immunization on an annual basis to all children, according to established national schedules.
Provide pneumococcal immunization to all children, according to established national schedules.

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  • Breastfeeding

  • Avoidance of smoke exposure

  • Prophylactic antibiotics