GPAtlas🧭 When to suspect
Suspect acute otitis media (AOM) – acute inflammation of the middle ear with an effusion – in any patient, but especially a young child (peak incidence 6–18 months), presenting with the rapid onset of otalgia and signs of a middle-ear infection. Fever, irritability and disturbed sleep are common, and most episodes follow a recent upper respiratory tract infection (URTI).
AOM is self-limiting: symptoms last about 3 days (occasionally up to a week), and the majority of children recover within 3 days without antibiotics. It is caused by viruses and bacteria, which are often present together and cannot be distinguished clinically. Diagnosis is made on otoscopy: a bulging, red or cloudy tympanic membrane (TM) with loss of the light reflex, signifying middle-ear effusion plus acute infection.
The two clinical priorities in primary care are to secure the diagnosis (a red TM alone is not enough – look for bulging), provide effective analgesia while reserving antibiotics for those who benefit, and to never miss the rare serious complication. It is worth distinguishing AOM from its two common mimics at the outset.
| Acute otitis media (AOM) | Otitis media with effusion (OME / glue ear) |
Otitis externa |
|---|---|---|
| Rapid-onset otalgia + fever after a URTI; bulging, red or cloudy TM; unwell child. | Painless; dull or retracted TM with a fluid level; the main problem is reduced hearing; no acute infection. | Pain on moving the tragus or pinna; red, swollen, weepy ear canal; TM often normal; the “swimmer’s ear”. |
| Analgesia first; targeted antibiotic only. | Watchful waiting; audiometry; grommets if persistent. | Aural toileting + topical drops; keep the ear dry. |
Source: NICE NG91
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