Acute otitis media (AOM) is an ear infection that causes inflammation in the middle ear, often accompanied by fluid, pain, or drainage. It most commonly affects infants and young children. Risk factors include daycare attendance, exposure to smoke, bottle feeding while lying down, and recent illness. The infection is caused by both bacterial and viral factors. Diagnosis can be difficult as symptoms vary and testing on young children is challenging. Treatment may include pain medication and antibiotics, depending on a child's age, symptoms, and medical history.

2. What is AOM?

3.  Acute otitis media: Inflammation of the middle ear
in which there is fluid in the middle ear
accompanied by signs or symptoms of ear infection:
a bulging eardrum usually accompanied by pain; or
a perforated eardrum, often with drainage of
purulent material (pus). Acute otitis media is the
most frequent diagnosis in sick children in the U.S.,
especially affecting infants and preschoolers.
Almost all children have one or more bouts of otitis
media before age 6.
 http://www.medicinenet.com/script/main/art.asp?articlekey=26131

4. Risk Factors
 Risks factors can be any of the following: (Medline Plus)

 Attending day care (especially those with more than 6 children)
 Changes in altitude or climate Cold climate
 Exposure to smoke Family history of ear infections
 Not being breastfed Pacifier use
 Recent ear infection Recent illness of any type
 Drinking from Sippy cups Drinking a bottle while lying down

 Medline Plus (2014) “Ear infection – acute”, Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant
Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve,
MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
https://www.nlm.nih.gov/medlineplus/ency/article/000638.htm

5. Pathogenesis
 The pathogenesis of OM is multifactorial, involving
the adaptive and native immune system,
Eustachian-tube dysfunction, viral and bacterial
load, and genetic and environmental factors.
 Rovers, MM., Schilder, AGM., Zielhuis, GA., Rosenfeld, RM., “Otitis media”, THE LANCET Vol
363 • February 7, 2004 • www.thelancet.com

6. Pathophysiology
 “The pathophysiology of acute otitis media is
complex and multifactorial. It is characterized by
inflammation of the middle ear with an infiltration
of leukocytes, macrophages and mast cells. The
resulting effusion contains a large amount of
inflammatory mediators, among which are
cytokines.”
 Barzilai, A., Dekel, B., Dagan, R., Leibovitz, “Middle ear effusion IL-6 concentration in bacterial
and non-bacterial acute otitis media”, Acta Psediatr 89: 1068-71. Taylor & Francis. ISSN 0803-
5253

7. Diagnosis
 Despite numerous investigations precise diagnosticcriteria and
optimal treatment for acute otitis media remain uncertain and
controversial.
 History of prior infections, symptoms and physical findings
are all used. Perforation of the tympanic membrane was also
seen as a criteria. Tympanometry is often not valid because of
the difficulty in gaining cooperation from the child.
 “The fact that doctors were very certain of their diagnosis in
only 58% of children aged 0-12 months is disconcerting.”
 Diagnosis is difficult and not always reliable, thus the
controversy surrounding the use of antibiotics for this illness.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1662354/pdf/bmj00168-0036.pdf

8. Treatment
 Pain should be controlled
 Antibiotics should be prescribed for AOM in children 6 month or older with
severe symptoms of at least 48 hours duration or temperature of 102 F or
higher
 Antibiotics should be prescribed for children 6 months to 23 months without
severe symptoms
 For children without severe symptoms or non severe AOM observation
should be provided with close follow-up to monitor need for antibiotics.
 Prophylactic antibiotics should not be prescribed to reduce the frequency of
episodes of AOM in children with recurrent AOM. Tympanostomy tubes may
be offered for recurrent AOM (3 episodes in 6 months or 4 episodes in 1 year
with 1 episode in the preceding 6 months).
http://www.aafp.org/patient-care/clinical-recommendations/all/otitis-media.html

9. Summary
 Acute Otitis Media is the scourge of parents and young children
around the world. Infants as young as 1 month can develop the
painful infection of the middle ear. Their short Eustachian tubes
block drainage from the middle ear and this fluid can become
infected. Most episodes will clear on their own but some persist
and will need antibiotics. Some prevention ideas include a diet of
fresh foods, avoidance of sugary drinks and processed foods. If
the young children are bottle fed, it should be done in an upright
position. Treatment varies and is individualized based on age,
severity of symptoms and child’s history of infections. AOM is a
common child hood illness and it can be treated and held to a
minimum with proper care and supervision. Without care and
supervision it can develop into a chronic, reoccurring illness that
can damage the middle ear causing hearing loss and painful
attacks. AOM, although not itself serious is not to be ignored but
managed with care.