Acute otitis media is a common affliction of the middle ear in pediatric population that usually presents with acute pain, fever, hearing loss and discharge from the ear. Usually, conditions leading to the significant eustachian tube problems with its obstruction cause acute otitis media. Most common include acute infections of the upper respiratory tract and coincidence of adenoid hypertrophy in children.


The picture below: acute otitis media, right ear, 5-year-old child. The tympanic membrane is bulging, opaque, red. Cone of light is invisible. The tympanic cavity is filled with a large amount of viscous fluid which is purulent. Only small region of lateral process of the malleus is visible, all other structures including normally well visible handle of the malleus are covered with thickened tympanic membrane. One can see hypervascularity of the entire of the tympanic membrane. High pressure in tympanic cavity causes bulging of tympanic membrane and if exceeds its resistance, causes perforation with subsequent discharge from the ear. The acute otitis media in this stage can be easily recognized in otoscopy (fig. 1).

In this stage symptoms will include pain, high fever, aural fullness, plugged ear, noticeable hearing loss. The pain is mild to severe and usually reduces after spontaneous perforation of the tympanic membrane or surgical management. There can be symptoms associated with adenoid or tonsils hypertrophy, upper respiratory tract infections and other.

Acute otitis media
Fig. 1 Acute otitis media
  • Because this was uncomplicated acute otitis media with moderate symptoms, the treatment was pharmacological.
  • Causal treatment: antibiotics (10 days).
  • Symptomatic management: analgesics and antipyretics.
  • Nasal symptoms relieving: decongestants (3 – 5 days) and nasal sprays with steroids (2 weeks).
  • AOM resolved without surgical intervention, leaving middle ear effusion for another 3 weeks.
  • There are numerous papers on acute otitis media in the Internet, you can read e.g. “Acute Otitis Media Treatment and Management” by John D Donaldson et al. in Medscape.