Acute otitis media (AOM) is an acute inflammatory condition of the mucosal lining of the tympanic cavity, primarily resulting from Eustachian tube dysfunction and infection. It is characterized by middle ear effusion and signs of acute inflammation. Duration: up to 3 weeks.
Etiology and Risk Factors
Pathogens (proven by culture and PCR):
- Bacteria: Streptococcus pneumoniae (~40%), Haemophilus influenzae (~30%), Moraxella catarrhalis (~10–15%)
- Viruses: RSV, influenza, parainfluenza, adenovirus, coronavirus, rhinovirus
Evidence-based risk factors:
- Age under 5 years (immature immunity, anatomical features of Eustachian tube)
- Formula feeding (lack of IgA and immune components of breast milk)
- Passive smoking (impairs mucociliary clearance)
- Adenoid hypertrophy (obstruction of Eustachian tube)
- Attending childcare (frequent respiratory infections)
- Genetic predisposition
- Barotrauma (aviation, diving)
- Immunodeficiency states
Classification
By duration:
- Acute: ≤3 weeks
- Subacute: 3–12 weeks
- Chronic: >12 weeks
By clinical type:
- Non-perforated
- Perforated with otorrhea
- AOM in the context of otitis media with effusion
By severity:
- Mild
- Moderate
- Severe (fever >39°C, pain >48 h)
Symptoms
Children:
- Ear pain
- Fever
- Irritability, poor sleep
- Hearing loss
- Otorrhea
Adults:
- Ear pain
- Fever (less common)
- Hearing loss
- Headache, fullness
- Balance disturbance (rare)
Diagnosis
Clinical diagnosis based on:
- Middle ear effusion (bulging tympanic membrane, reduced mobility)
- Signs of inflammation (erythema, fever)
- Additional: tympanometry, audiometry, CT/MRI if complications suspected
Treatment
1. Pain relief:
Paracetamol, ibuprofen
2. Antibiotic therapy (indications):
- Children <6 months
- Children 6–23 months with bilateral AOM
- Severe symptoms, otorrhea
- Adults with significant pain
- Course: 5–7 days (children >2 years, adults), 10 days (<2 years or complications)
3. Local treatment:
Otit drops with antibiotics (in otorrhea)
Complications
- Mastoiditis
- Tympanosclerosis
- Persistent perforation
- Sensorineural hearing loss
- Meningitis, brain abscess
- Facial nerve palsy
- Chronic otitis media
When to Consult a Physician
- Ear pain >2 days, fever >39°C
- Hearing loss >1 week
- Recurrent AOM (≥3 episodes in 6 months)
- Ear discharge
- Suspected complications (postauricular swelling, headache, neurological signs)