Acute Otitis Media

Diagnosis criteria

  • AOM: bulging, inflamed eardrum OR acute inflammation and decreased mobility on pneumatoscopy (symptoms: fever, pain, irritability)
  • Myringitis: normal mobility on pneumatoscopy with peripheral redness
  • OME: visible fluid or reduced mobility on pneumatoscopy without acute inflammation


  • S. pneumoniae (40%), H. influenzae (25%), M. catarrhalis (10%), GAS (2%), S. aureus (2%)


  • Hearing loss
  • TM perforation
  • Chronic suppurative otitis media
  • Tympanosclerosis
  • Cholesteatoma
  • Acute mastoiditis
  • Facial nerve paralysis
  • Bacterial meningitis



  • Amoxicillin 40mg/kg/day PO divided tid x 5 days
  • Azithromycin 10mg/kg/day 1st day, then 5mg/kg/day x 4 days
  • Treat for longer (10d) at a higher dose (90mg/kg/day) if pt has received abics in last 3 months, attends daycare, or has recurrent disease.
  • Antibiotics prophylaxis is not recommended

Indications for ENT referral (tympanostomy)

  • OME for ≥2 months with bilateral hearing loss ≥20dB
  • ≥3 episodes in 6 months
  • ≥4 episodes in 12 months
  • Retracted tympanic membrane

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