The term otitis media (OM) refers to inflammation of the middle ear. There are several subtypes:

Acute otitis media (AOM)

Acute otitis media (AOM) has an infective cause, most commonly with both bacteria and viruses present at the same time. More than three-quarters of AOM cases are in children under 10 years of age, with peak incidence between six and 15 months. As well as bacteria and viruses, other risk factors include passive smoking, attendance at a childcare setting, formula feeding and craniofacial abnormalities such as Down’s syndrome or cleft palate. 

Earache is the main symptom, although in younger children, there may also be fever, poor feeding, restlessness, cough, rhinorrhoea (runny nose), and pulling or rubbing of the ear.

Symptomatic treatment with simple analgesics may be all that is needed as most cases improve rapidly, resolving spontaneously within a few days. A five-day course of amoxicillin or erythromycin is appropriate for those who are systemically unwell, at high risk of serious complications because of lowered immunity or other significant health problems, or who have had symptoms that have not improved for four days or more.

Children with a perforated eardrum or who have bilateral AOM (affecting both ears) may also benefit from antibiotics. Hospital admission is advisable for any individual younger than three months with a temperature higher than 38˚C; three- to six-month-olds with a fever in excess of 39˚C; anyone who is systemically very unwell, or who may have serious complications such as meningitis, mastoiditis, intracranial abscess, sinus thrombosis or facial nerve paralysis.

Recurrent AOM is usually diagnosed if a person has experienced three or more separate episodes of AOM over six months. The risk of recurrent AOM is seemingly higher during the winter and in those who suffer AOM before six months of age, have gastroesophageal reflux disease (GORD), use dummies or feed while lying down. Management is the same as for AOM, plus minimising risk factors if possible. Provide reassurance that the frequency of episodes should reduce with age.