What is Acute Otitis Media?
Have you ever seen a child tugging at their ear, crying in discomfort, especially after a cold? Chances are, they may be dealing with Acute Otitis Media (AOM) — a common middle ear infection.
In simpler terms, AOM is an inflammation and infection of the middle ear (the air-filled space behind the eardrum). It’s most common in children under the age of 5, although adults can get it too. According to the American Academy of Pediatrics, about 80% of children will have at least one episode by the age of 3.
How Does It Happen?
Let’s imagine the ear as a tiny tunnel system. One of the tunnels, called the Eustachian tube, connects the middle ear to the back of the throat. Its job? To balance air pressure and drain fluid.
Now, picture this: after a cold or throat infection, this Eustachian tube swells up or gets blocked — like a clogged drain. Fluid builds up behind the eardrum. And bacteria or viruses love that warm, moist place. They multiply, causing inflammation and pain — voilà! That’s acute otitis media.
What Are the Causes of Acute Otitis Media?
AOM typically develops after a viral upper respiratory tract infection, like a cold. Here’s a breakdown of the main culprits:
- Viral infections – Respiratory syncytial virus (RSV), rhinovirus, influenza: Account for 30–50% of AOM cases.
- Bacterial infections – Especially Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, which cause up to 70% of cases either alone or in combination with viruses.
- Allergies – They can cause Eustachian tube blockage and fluid buildup.
- Environmental triggers – Smoke exposure and bottle feeding while lying flat may contribute too.
So yes — it’s usually not “just a cold.” The cold sets the scene, and bacteria or viruses move in like uninvited guests.
What Puts You at Risk?
Before you panic every time your child sniffles, let’s look at who’s more likely to get AOM. While anyone can get it, some people are more vulnerable.
Here are the top risk factors:
- Age – Kids between 6 months and 2 years are most affected due to smaller Eustachian tubes.
- Daycare attendance – Close contact spreads germs quickly.
- Bottle-feeding – Especially while lying down.
- Pacifier use – May alter pressure in the ear.
- Exposure to smoke – Secondhand smoke irritates the ear and airway linings.
- Family history – Genetics can play a role.
- Season – More common during fall and winter.
- Cleft palate or Down syndrome – These conditions affect Eustachian tube function.
Among these, age and daycare attendance are two of the strongest predictors.
What Are the Symptoms?
Let’s talk about the signs — because a child with AOM may not be able to tell you what hurts.
The most common symptom is ear pain (otalgia). In young children, you may also see:
- Tugging or rubbing the ear
- Crying more than usual
- Trouble sleeping
- Fever (often over 38°C/100.4°F)
- Fluid draining from the ear (if eardrum bursts)
- Trouble hearing
- Loss of balance
- Irritability or fussiness
But why does the ear hurt so badly? That fluid and pus buildup creates pressure behind the eardrum — it’s like blowing air into a balloon until it stretches painfully tight.
If the pressure gets too high, the eardrum may rupture, releasing pus and reducing the pain suddenly — but also indicating serious inflammation.
What Could It Be Besides AOM? (Differential Diagnosis)
Many conditions mimic the symptoms of AOM. It’s important to rule them out:
- Otitis externa (swimmer’s ear) – Infection of the ear canal, not the middle ear. Pain increases when the ear is touched or moved.
- Teething in infants – Can cause ear-tugging and fussiness.
- Temporomandibular joint (TMJ) dysfunction – Jaw pain that radiates to the ear.
- Foreign body in the ear – Common in toddlers.
- Eustachian tube dysfunction – Without infection, just pressure.
A good physical exam, history, and sometimes tests are needed to pin down the exact cause.
How Do Doctors Diagnose Acute Otitis Media?
AOM is primarily diagnosed by clinical examination. The gold standard? Otoscopy.
A doctor uses a lighted instrument (otoscope) to look inside the ear. They may see:
- A red, bulging eardrum
- Fluid behind the eardrum (may look yellow or cloudy)
- Poor mobility of the eardrum when puffing air into it (pneumatic otoscopy)
In some cases, tympanometry may be used — a test that measures the movement of the eardrum.
Ear discharge (otorrhea) suggests perforation, which confirms the diagnosis too.
If the infection doesn’t improve or recurs frequently, your doctor may take a sample of ear fluid for lab testing to identify bacteria.
Treatment: How Is Acute Otitis Media Managed?
Let’s talk about relief — because when your child is in pain, you want answers fast.
First, not all cases need antibiotics right away. Why? Because many are caused by viruses, which don’t respond to antibiotics. And even bacterial AOM can resolve on its own, especially in children over 2.
When to Watch and Wait
For healthy children:
- Over 2 years old with mild symptoms? Doctors may wait 48–72 hours before starting antibiotics.
When to Use Antibiotics
Antibiotics are recommended when:
- Symptoms are severe (moderate/severe pain or fever >39°C/102.2°F)
- The child is under 6 months old
- Both ears are affected in children under 2
- There is ear discharge
First-line antibiotic:
- Amoxicillin (80–90 mg/kg/day, divided twice daily) for 5–10 days
If there’s no improvement after 48–72 hours:
- Amoxicillin-clavulanate
- Or cephalosporins (e.g., cefdinir, cefuroxime)
For pain and fever:
- Paracetamol or ibuprofen helps manage symptoms.
Recurrent AOM? Consider:
- Ear tubes (tympanostomy) for drainage
- Referral to an ENT specialist
Avoid antihistamines and decongestants — they don’t help in AOM and may have side effects.
Final Thoughts
Acute otitis media might be common — but it shouldn’t be ignored. With proper care, most children recover fully. But repeated infections can affect hearing, speech development, and school performance.
So, the next time your little one has a cold and starts rubbing their ear — don’t brush it off. A quick doctor’s visit might spare them days of pain.
References
- American Academy of Pediatrics. (2013). The diagnosis and management of acute otitis media. https://pediatrics.aappublications.org/content/131/3/e964
- Centers for Disease Control and Prevention (CDC). Acute Otitis Media (Middle Ear Infection). https://www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/ear-infection.html
- National Institute on Deafness and Other Communication Disorders (NIDCD). Ear Infections in Children. https://www.nidcd.nih.gov/health/ear-infections-children
- Lieberthal AS, Carroll AE, Chonmaitree T, et al. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), e964–e999. https://doi.org/10.1542/peds.2012-3488