Lightning Learning: Otitis Media (Diagnosis & Management)

Lightning Learning: Otitis Media (Diagnosis & Management)


80% of children experience at least one episode of Acute Otitis Media (AOM) before 2 years. AOM occurs in <1% of adults.

Risk Factors

  • Children with anatomical anomalies (e.g. cleft palate) or immunological deficiencies.

  • Environmental: childcare attendance, exposure to older siblings, exposure to tobacco smoke, bottle feeding in a supine position, dummy use.

  • Male

  • Family history of AOM

  • Certain ethnic groups (Native Americans & Native Alaskans)


Key factors of history will vary with age. Discussed by CKS NICE.

Examination (not exhaustive)

  • Bulging (bagel sign) red tympanic membrane

  • Loss of Light reflex

  • +/- discharge


Aetiology? Mostly caused by respiratory viruses. Bacterial causes Streptococcus pneumoniae (40%), Haemophilus influenzae (25-30%).


80% of children experience at least one episode of Acute Otitis Media (AOM) before 2 years.

“How should I manage people at their initial presentation?”

Admit if…

  • Person with severe infection

  • Person with suspected complications of AOM

  • Child <3 months with temp >38°C

Consider admission if…

  • Child <3 months old

  • Child 3-6 months with temp >39°C

All people with AOM

  • Course of AOM 3-7 days

  • Advise regular analgesia such as paracetamol/ibuprofen


Who benefits from immediate antibiotics?

  • Those with presence of otorrhoea

  • Anyone aged less than 2 years with bilateral infection

  • The systemically unwell

  • Those with high risk of complications.

What about delayed prescriptions?

Expert consensus suggests that AOM could be viral or bacterial and distinguishing can be difficult. Therefore, backup or no antibiotic prescription could be considered in most children with AOM.

Between 2-5 years you need to treat 16,000 children for AOM to prevent 1 case of mastoiditis.


Treatment? Amoxicillin or Erythromycin/Clarithromycin

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