Acute otitis media in children

Overview

Otitis media, including acute otitis media (AOM) and otitis media with effusion (OME, also known as 'glue ear'), is one of the most common childhood conditions. While closely related, AOM and OME are two different, distinct conditions. AOM is characterised by the presence of middle-ear effusion together with an acute onset of signs and symptoms caused by middle ear inflammation.[1] Symptoms of AOM include earache in older children; or pulling, tugging, or rubbing of the ear or non-specific symptoms such as fever, irritability, or poor feeding in younger children. AOM signs include a distinctly red, yellow, or cloudy tympanic membrane.[2] AOM diagnosis is strengthened by the presence of a bulging tympanic membrane, an air-fluid level behind the tympanic membrane, tympanic membrane perforation, and/or discharge in the ear canal.[2] Pneumatic otoscopy and/or tympanometry can be used to assess the presence (or absence) of middle ear effusion (MEE).[3]In children with ventilation tubes (grommets) in place, ear discharge is a symptom of AOM whereby fluid that has built up in the middle ear drains through the tube into the child's ear canal.[4] Interventions for ear discharge associated with ventilation tubes are beyond the scope of this review. While most children have occasional AOM episodes, an important subset suffer from recurrent AOM, defined as three or more episodes in 6 months or four episodes in 1 year.[5] Middle ear effusion without signs of an acute infection indicates OME (see review on Otitis media with effusion), which can arise as a result of AOM, but can also occur independently. Chronic suppurative otitis media (CSOM, see review on CSOM) is characterised by continuing (>3 months) middle-ear inflammation and ear discharge through the tympanic membrane (perforation or ventilation tubes). Interventions for these conditions are assessed in separate reviews in Clinical Evidence (see review links above). For the purposes of this review, the age range used to define children is from birth to 15 years of age.

Latest citations

Management of acute otitis media: update. ( 22 September 2014 )

Ibuprofen, paracetamol, and steam for patients with respiratory tract infections in primary care: pragmatic randomised factorial trial. ( 22 September 2014 )