Acute Otitis Media in Children

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Acute Otitis Media in Children

Quick Reference

Critical Alerts

  • Diagnosis requires THREE criteria: Acute onset + middle ear effusion + signs of inflammation
  • Visualization of tympanic membrane is mandatory: Bulging TM is most specific finding
  • Not all ear pain is otitis media: Differentiate from otitis externa, OME, referred pain
  • Watchful waiting is evidence-based: Valid strategy for children ≥2 years with mild, unilateral AOM
  • High-dose amoxicillin (80-90 mg/kg/day) is first-line: Overcomes resistant pneumococci
  • Pain management is often undertreated: Should be first priority regardless of antibiotic decision
  • Mastoiditis requires urgent intervention: Post-auricular swelling, tenderness, proptosis of auricle
  • Recurrent AOM defined as ≥3 episodes in 6 months or ≥4 in 12 months: Consider ENT referral for tympanostomy tubes

Diagnostic Criteria (AAP 2013)

ALL THREE required for diagnosis [1]:

  1. Acute onset of symptoms (less than 48 hours): otalgia, fever, irritability
  2. Middle ear effusion confirmed by: bulging TM, decreased/absent mobility on pneumatic otoscopy, air-fluid level, or otorrhea
  3. Signs of middle ear inflammation: moderate-to-severe TM bulging OR new-onset otorrhea OR mild TM bulging with recent (less than 48h) otalgia or intense erythema