FEBRUARY 8TH, 2023

Acute Otitis Media (AOM): Inflammation and infection of the middle ear in which fluid is trapped behind the eardrum. 

• Presenting symptoms: Tugging or pulling of the ears, fussiness and crying, trouble sleeping, fever (especially in infants and younger children), trouble sleeping, fluid draining from the ear, clumsiness or problems with balance, trouble hearing or responding to quiet sounds 

• Epidemiology: Children >> adults. 80% of children will experience otitis media before school years. Risk factors contribute to eustachian tube dysfunction such as craniofacial abnormalities, recurrent URIs, supine bottle feeding (reflux into ear), pacifier use, secondhand smoke, and adenoid hypertrophy among others. 

• Etiology/Pathophysiology: Blockage of eustachian tube (more common in pediatrics due to horizontal plane of childhood tube; see figure) creates negative pressure, which generates a transudate collection in the middle ear and leads Inflammation and infection. The most common bacterial etiologies include:  S.pneumoniae, H. influenzae (non-typable), and Moraxella catarrhalis, which may or may not be preceded by viral infection. 

• Diagnosis: Primary diagnosis is made with direct visualization of the eardrums via otoscopy. A red and enlarged eardrum is indicative of an ear infection. Pneumatic insufflation is used to check for fluid behind the eardrum. (An eardrum with fluid behind it will move less easily than an eardrum without fluid behind it). Additional testing may include  tympanometry (assessing flexibility of the eardrum at different pressures) or audiogram (CHL < 30 dB). 

• Treatment: AOM is commonly overtreated and may be observed for 48-72 hrs in children > 6 months. Amoxicillin is typically prescribed to be taken for 7-10 days with resolution of symptoms occurring within the first 48-72 hrs. Additional analgesics may aid in symptom management. Repeated AOM may indicate need for tympanostomy (see link below for criteria).

• Complications: TM perforation, hearing loss, tympanosclerosis, mastoiditis, labyrinthitis, petrositis, brain abscess, labyrinthine fistula, facial nerve paralysis, meningitis, otitic hydrocephalus. 

MedlinePlus. Bethesda (MD): National Library of Medicine (US); updated Feb 24, 2022. Eustachian Tube.

Middle ear infection (Otoscopy)

Middle Ear Infection Images. University of Texas Health Houston McGovern Medical School, Otolaryngology - Head and Neck Surgery. Accessed 5 February 2023. 

Further Reading: 
General
Natural history
Pediatric Tympanostomy Guidelines
Otitis Media with Effusion
Chronic Suppurative Otitis Media (CSOM)
Complications

Written by: Phuong (Alexandria) Bao