Acute Otitis Media (Ear Infection): Symptoms, Causes, Treatment & Prevention in Children

Definition

Acute otitis media (AOM) is a bacterial or viral infection of the middle ear space behind the tympanic membrane. Peak incidence: 6–24 months.

Symptoms

• Ear pain (otalgia) — often severe, worse lying down
• Fever (may be high in young children)
• Irritability, fussiness, poor sleep
• Tugging/rubbing ear
• Hearing difficulty (fluid dampens sound)
• Otorrhea (purulent drainage if TM ruptures)
• Decreased appetite, vomiting, diarrhea (especially infants)

Causes

• Bacterial: Streptococcus pneumoniae, Haemophilus influenzae (non-typeable), Moraxella catarrhalis — ~70% of cases.
• Viral: RSV, influenza, rhinovirus — often precede bacterial superinfection.
• Eustachian tube dysfunction: Horizontal, short, floppy tube in children impairs drainage/ventilation.

Risk Factors

• Age <2 years, daycare attendance, bottle-feeding supine, secondhand smoke, pacifier use, cleft palate, allergic rhinitis, adenoid hypertrophy, immunodeficiency.

Treatment

• Antibiotics (if bacterial): Amoxicillin 80–90 mg/kg/day × 10 days (first-line). Alternatives for penicillin allergy: cefdinir, azithromycin, clindamycin.
• Observation option: For mild unilateral AOM in children >2 years, watchful waiting 48–72 hrs with analgesia.
• Analgesia: Acetaminophen or ibuprofen (weight-based). Topical benzocaine drops (if TM intact).
• Adjuncts: Warm compress, hydration, elevation.

Prevention

• PCV13/PCV15/PCV20 and Hib vaccines.
• Exclusive breastfeeding ≥6 months.
• Avoid bottle propping/supine feeding.
• Eliminate secondhand smoke.
• Limit pacifier after 6 months.
• Treat allergic rhinitis; consider adenoidectomy if chronic.

When to Refer

• Age <6 months with AOM symptoms.
• No improvement in 48–72 hrs on antibiotics.
• Recurrent AOM (≥3 in 6 mo or ≥4 in 12 mo).
• Complications: mastoiditis, facial palsy, meningitis signs.