GPAtlas🧭 When to suspect
Suspect acute otitis media (AOM) – acute inflammation of the middle ear with an effusion – in any patient presenting with the rapid onset of otalgia and signs of a middle-ear infection.
• Especially in a young child (peak incidence 6–18 months).
• Fever, irritability and disturbed sleep are common.
• 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
• 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 or 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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