Approach Considerations

Culture and sensitivity of a specimen from a fresh perforation or a tympanocentesis may be helpful.

Computed tomography (CT) may be necessary to determine if a complication has occurred; otherwise, imaging studies are unnecessary. Magnetic resonance imaging (MRI) might be more appropriate for diagnosing suspected intracranial complications.

All children with acute otitis media (AOM) have conductive hearing loss associated with the middle ear effusion; consequently, testing in the acute phase is probably unhelpful. Tympanometry may assist in the diagnosis of middle ear effusion but, for the skilled pneumatic otoscopist, is seldom necessary.

Tympanocentesis

Tympanocentesis involves aspiration of the contents of the middle ear cleft by piercing the tympanic membrane with a needle and collecting that material for diagnostic examination. Normally, the hole is small enough to permit healing within 1 or 2 days.

Tympanocentesis should be performed in the following AOM patients:

Neonates who are younger than 6 weeks (and therefore are more likely to have an unusual or more invasive pathogen)
Patients who are immunosuppressed or immunocompromised
Patients in whom adequate antimicrobial treatment has failed and who continue to show signs of local or systemic sepsis
Patients who have a complication that requires a culture for adequate therapy

Laboratory Studies

A study by Pichichero and Almudevar indicated that the presence of AOM caused by nontypeable H influenzae, as well as the disease’s cure, can be determined from serum levels of S100A12 protein and interleukin-10 (IL-10).^[21]

Treatment & Management

Rettig E, Tunkel DE. Contemporary concepts in management of acute otitis media in children. Otolaryngol Clin North Am. 2014 Oct. 47 (5):651-72. [QxMD MEDLINE Link]. [Full Text].
Minovi A, Dazert S. Diseases of the middle ear in childhood. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2014. 13:Doc11. [QxMD MEDLINE Link]. [Full Text].
Danishyar A, Ashurst JV. Otitis, Media, Acute. 2018 Jan. [QxMD MEDLINE Link]. [Full Text].
Sakulchit T, Goldman RD. Antibiotic therapy for children with acute otitis media. Can Fam Physician. 2017 Sep. 63 (9):685-7. [QxMD MEDLINE Link]. [Full Text].
Clements DA, Langdon L, Bland C, Walter E. Influenza A vaccine decreases the incidence of otitis media in 6- to 30- month-old children in day care. Arch Pediatr Adolesc Med. 1995 Oct. 149(10):1113-7. [QxMD MEDLINE Link].
Bernstein JM. The role of IgE-mediated hypersensitivity in the development of otitis media with effusion. Otolaryngol Clin North Am. 1992 Feb. 25(1):197-211. [QxMD MEDLINE Link].
Pichichero ME, Chapman TJ, Bajorski P. Pneumonia, Sinusitis, Influenza and Other Respiratory Illnesses in Acute Otitis Media-Prone Children. Pediatr Infect Dis J. 2021 Nov 1. 40 (11):975-80. [QxMD MEDLINE Link]. [Full Text].
American Academy of Pediatrics. Respiratory syncytial virus. Red Book: Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, Ill: 2006. 560-566.
Arola M, Ruuskanen O, Ziegler T, et al. Clinical role of respiratory virus infection in acute otitis media. Pediatrics. 1990 Dec. 86(6):848-55. [QxMD MEDLINE Link].
Arola M, Ziegler T, Ruuskanen O. Respiratory virus infection as a cause of prolonged symptoms in acute otitis media. J Pediatr. 1990 May. 116(5):697-701. [QxMD MEDLINE Link].
Block SL. Causative pathogens, antibiotic resistance and therapeutic considerations in acute otitis media. Pediatr Infect Dis J. 1997 Apr. 16(4):449-56. [QxMD MEDLINE Link].
American Academy of Pediatrics. Pneumococcal infections. Red Book: Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, Ill: 2006. 525-537.
American Academy of Pediatrics. Haemophilus influenzae infections. Red Book: Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, Ill: 2006. 310-3318.
Martin JM, Hoberman A, Shaikh N, et al. Changes Over Time in Nasopharyngeal Colonization in Children Under 2 Years of Age at the Time of Diagnosis of Acute Otitis Media (1999-2014). Open Forum Infect Dis. 2018 Mar. 5 (3):ofy036. [QxMD MEDLINE Link]. [Full Text].
Chonmaitree T, Trujillo R, Jennings K, et al. Acute Otitis Media and Other Complications of Viral Respiratory Infection. Pediatrics. 2016 Mar 28. [QxMD MEDLINE Link].
American Academy of Pediatrics. Group A streptococcal infections. Red Book: Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, Ill: 2006. 610-620.
Paradise JL, Rockette HE, Colborn DK, et al. Otitis media in 2253 Pittsburgh-area infants: prevalence and risk factors during the first two years of life. Pediatrics. 1997 Mar. 99(3):318-33. [QxMD MEDLINE Link].
Megged O, Abdulgany S, Bar-Meir M. Does Acute Otitis Media in the First Month of Life Increase the Risk for Recurrent Otitis?. Clin Pediatr (Phila). 2018 Jan. 57 (1):89-92. [QxMD MEDLINE Link].
King LM, Bartoces M, Hersh AL, Hicks LA, Fleming-Dutra KE. National Incidence of Pediatric Mastoiditis in the United States, 2000-2012: Creating a Baseline for Public Health Surveillance. Pediatr Infect Dis J. 2018 Mar 27. [QxMD MEDLINE Link].
Marchisio P, Esposito S, Picca M, et al. Prospective evaluation of the aetiology of acute otitis media with spontaneous tympanic membrane perforation. Clin Microbiol Infect. 2017 Jan 19. [QxMD MEDLINE Link].
Pichichero ME, Almudevar A. Serum cytokine biomarkers accurately predict presence of acute otitis media infection and recovery caused by Haemophilus influenzae. Int J Pediatr Otorhinolaryngol. 2016 Apr. 83:200-4. [QxMD MEDLINE Link].
Thomas JP, Berner R, Zahnert T, et al. Acute otitis media-a structured approach. Dtsch Arztebl Int. 2014 Feb 28. 111(9):151-60. [QxMD MEDLINE Link]. [Full Text].
Tahtinen PA, Laine MK, Ruohola A. Prognostic Factors for Treatment Failure in Acute Otitis Media. Pediatrics. 2017 Sep. 140 (3):[QxMD MEDLINE Link].
Basco WT. Predicting Treatment Failure in Kids With AOM. Medscape. 2017 Nov 27. [Full Text].
Boggs W. Antimicrobial Treatment of Acute Otitis Media Shortens Duration of Middle Ear Effusion. Medscape. May 9 2014. [Full Text].
Tapiainen T, Kujala T, Renko M, et al. Effect of Antimicrobial Treatment of Acute Otitis Media on the Daily Disappearance of Middle Ear Effusion: A Placebo-Controlled Trial. JAMA Pediatr. 2014 May 5. [QxMD MEDLINE Link].
Barclay L. Postop Tympanostomy Tube Obstruction Common. Medscape Medical News. Jul 11 2014. [Full Text].
Conrad DE, Levi JR, Theroux ZA, et al. Risk Factors Associated With Postoperative Tympanostomy Tube Obstruction. JAMA Otolaryngol Head Neck Surg. 2014 Jul 10. [QxMD MEDLINE Link].
Fireman B, Black SB, Shinefield HR, et al. Impact of the pneumococcal conjugate vaccine on otitis media. Pediatr Infect Dis J. 2003 Jan. 22(1):10-6. [QxMD MEDLINE Link].
Hasegawa J, Mori M, Showa S, et al. Pneumococcal vaccination reduced the risk of acute otitis media: a cohort study. Pediatr Int. 2015 Jan 23. [QxMD MEDLINE Link].
Tawfik KO, Ishman SL, Altaye M, Meinzen-Derr J, Choo DI. Pediatric Acute Otitis Media in the Era of Pneumococcal Vaccination. Otolaryngol Head Neck Surg. 2017 Mar 1. 194599817699599. [QxMD MEDLINE Link].
Frellick M. Vaccines Have Changed the Epidemiology of Acute Otitis Media. Medscape Medical News. 2017 Aug 7. [Full Text].
Kaur R, Morris M, Pichichero ME. Epidemiology of Acute Otitis Media in the Postpneumococcal Conjugate Vaccine Era. Pediatrics. 2017 Aug 7. [QxMD MEDLINE Link]. [Full Text].
Teele DW, Klein JO, Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. J Infect Dis. 1989 Jul. 160 (1):83-94. [QxMD MEDLINE Link].
Hong W, Peng D, Rivera M, Gu XX. Protection against nontypeable Haemophilus influenzae challenges by mucosal vaccination with a detoxified lipooligosaccharide conjugate in two chinchilla models. Microbes Infect. 2010 Jan. 12 (1):11-8. [QxMD MEDLINE Link].
Azarpazhooh A, Limeback H, Lawrence HP, Shah PS. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database Syst Rev. 2011 Nov 9. 11:CD007095. [QxMD MEDLINE Link].
Danhauer JL, Johnson CE, Baker JA, et al. Will Parents Participate in and Comply with Programs and Regimens Using Xylitol for Preventing Acute Otitis Media in Their Children?. Lang Speech Hear Serv Sch. 2015 Feb 4. [QxMD MEDLINE Link].
Grindler DJ, Blank SJ, Schulz KA, et al. Impact of otitis media severity on children's quality of life. Otolaryngol Head Neck Surg. 2014 Mar 13. [QxMD MEDLINE Link].
Barclay L. Pediatric ear infection: updated AAP treatment guidelines. Medscape Medical News. February 25, 2013. Available at http://www.medscape.com/viewarticle/779817. Accessed: March 5, 2013.
[Guideline] Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013 Mar. 131(3):e964-99. [QxMD MEDLINE Link]. [Full Text].
University of Michigan Health System (UMHS). Otitis media. April 2013. Available at http://www.med.umich.edu/1info/FHP/practiceguides/om.html.
[Guideline] Rosenfeld RM, Schwartz SR, Pynnonen MA, et al. Clinical practice guideline: Tympanostomy tubes in children. Otolaryngol Head Neck Surg. 2013 Jul. 149 (1 Suppl):S1-35. [QxMD MEDLINE Link]. [Full Text].
Truffert E, Fournier Charrière E, Treluyer JM, Blanchet C, Cohen R, Gardini B, et al. Guidelines of the French Society of Otorhinolaryngology (SFORL): Nonsteroidal anti-inflammatory drugs (NSAIDs) and pediatric ENT infections. Short version. Eur Ann Otorhinolaryngol Head Neck Dis. 2019 Sep. 136 (4):289-294. [QxMD MEDLINE Link].

Media Gallery

Healthy tympanic membrane.
Tympanic membrane of a person with 12 hours of ear pain, slight tympanic membrane bulge, and slight meniscus of purulent effusion at bottom of tympanic membrane. Reproduced with permission from Isaacson G: The natural history of a treated episode of acute otitis media. Pediatrics. 1996; 98(5): 968-7.
Drawing of normal right tympanic membrane. Note outward curvature of pars tensa (*) of eardrum. Tympanic annulus is indicated anteriorly (a), inferiorly (i), and posteriorly (P). M = long process of malleus; I = incus; L = lateral (short) process of malleus.

of 3

Author

John D Donaldson, MD, FRCSC, FACS Pediatric Otolaryngologist, Chief of Surgery, Galisano Children's Hospital, Lee Memorial Health System

John D Donaldson, MD, FRCSC, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Society of Pediatric Otolaryngology, American Academy of Pediatrics, American College of Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Ted L Tewfik, MD Professor of Otolaryngology-Head and Neck Surgery, Professor of Pediatric Surgery, McGill University Faculty of Medicine; Senior Staff, Montreal Children's Hospital, Montreal General Hospital, and Royal Victoria Hospital

Ted L Tewfik, MD is a member of the following medical societies: American Society of Pediatric Otolaryngology, Canadian Society of Otolaryngology-Head & Neck Surgery

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Acknowledgements

John C Li, MD Private Practice in Otology and Neurotology; Medical Director, Balance Center

John C Li, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Tinnitus Association, Florida Medical Association, and North American Skull Base Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment