Otitis media is a general term for middle ear inflammation; acute otitis media (AOM) is associated with an infection while an otitis media with effusion (OME) is associated with fluid behind the tympanic membrane without an infection. The incidence of AOM is bimodal, with a first peak between the ages of 6 and 18 months of age and the second, smaller peak at 5 years. The diagnosis of AOM requires the presence of each of the following:

  • A history of recent and abrupt onset of signs and symptoms of middle ear inflammation and effusion.
  • The presence of a middle ear effusion (bulging of the tympanic membrane, limited or absent mobility of the membrane, tympanic membrane retraction, presence of air fluid level, or otorrhea).
  • Signs or symptoms of middle ear inflammation (either distinct erythema of the tympanic membrane or distinct otalgia).
  • A history of recent and abrupt onset of signs and symptoms of middle ear inflammation and effusion. A bulging tympanic membrane is the single finding most closely associated with acute otitis media. A bulging tympanic membrane in the setting of symptoms of acute infection has the highest predictive value for the presence of middle ear effusion.

Erythema of the ear canal and tympanic membrane (B) suggest increased vascularity from inflammation but is not sufficient for a diagnosis of AOM. Low grade fever and tugging at the ear (C) is part of a constellation of symptoms (ear pain, ear tugging, sleeplessness, irritability, decreased oral intake) commonly associated with AOM but have been confirmed by a 2009 study (Shaikh et al) that none of these symptoms were predictive without controlling for the presence of URI. Opacification of the tympanic membrane and air-fluid levels behind the tympanic membrane (D) are findings not specific to AOM and can also be found in children with otitis media with effusion.

Shaikh N, Hoberman A, Paradise JL, Wald ER, Switz Ge, Kurs-Lasky M, Colborn DK, Kearney DH, Zoffel LM. Development and preliminary evaluation of a parent-reported outcome instrument for clinical trials in acute otitis media. Pediatr Infect Dis J. 2009;28(1):5-8.

Shaikh N, Hoberman A, Rockette HE, Kurs-Lasky M. Development of an Algorithm for the Diagnosis of Otitis Media. Academic Pediatrics. 2012; 12(3):214-218.


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