Diagnosis and Management of Acute Otitis Media (AOM) vs Otitis Media with Effusion (OME)

✅ 1. Diagnosis of Acute Otitis Media (AOM)

Diagnostic Criteria — must have ALL:

A. Acute symptoms

• Fever

• Otalgia (ear pain)

• Irritability in children

• Otorrhea (only if TM perforation)

B. Middle-ear inflammation

Seen on otoscopy:

• Bulging tympanic membrane (TM) — most specific finding

• Erythema of TM

• Reduced mobility on pneumatic otoscopy

C. Middle-ear effusion

• Opaque TM

• Air-fluid level

• Loss of TM landmarks

👉 Bulging TM + acute ear pain = AOM until proven otherwise.

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✅ 2. Diagnosis of Otitis Media with Effusion (OME)

OME = Fluid in middle ear WITHOUT signs of acute inflammation.

Diagnostic Features:

• Hearing loss

• A “fullness” sensation

• TM retracted or neutral (NOT bulging)

• Air-fluid level

• Reduced TM mobility

• NO fever, NO acute pain

OME is usually viral or allergic, not bacterial.

📌 Summary Comparison

Feature	AOM	OME
Pain	✔️ Yes	❌ Usually no
Fever	✔️ Often	❌ No
TM bulging	✔️ Yes (hallmark)	❌ No
TM color	Red/yellow	Dull/gray
Mobility	Decreased	Decreased
Effusion	✔️ Yes	✔️ Yes
Cause	Mostly bacterial	Viral/allergic/fluid retention

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🩺 3. Management of Acute Otitis Media (AOM)

A. First-Line Antibiotic (if indicated)

Amoxicillin (80–90 mg/kg/day) divided BID for 5–10 days

• Adults: Amoxicillin 500 mg TID × 5–7 days

When to treat with antibiotics?

Give antibiotics	Observe
< 6 months	≥ 2 years + mild symptoms
6–23 months with definite AOM	Unilateral AOM, mild symptoms
Severe illness (fever ≥39°C, severe pain)	Reliable follow-up

B. Second-Line Antibiotics

Use if:

• Received amoxicillin in past 30 days

• Concomitant purulent conjunctivitis

• No improvement in 48–72h

→ Amoxicillin-Clavulanate (90 mg/kg/day) OR → Cefdinir / Cefpodoxime / Cefuroxime OR → IM Ceftriaxone (1–3 days)

C. Supportive Care

• Ibuprofen or Acetaminophen

• Warm compress

• Adequate hydration

Avoid

❌ Decongestants ❌ Antihistamines ❌ Steroids They do not help in AOM (per AAP guidelines).

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🩺 4. Management of Otitis Media With Effusion (OME)

Most important:

📌 OME does NOT require antibiotics 📌 OME does NOT require steroids 📌 Watchful waiting for 3 months is standard (AAP/AAO-HNS guidelines)

Management Plan

1. Watchful waiting for 3 months

2. Hearing assessment if:

   • OME persists >3 months

   • Speech delay

   • Developmental disorders

3. Environmental modification

   • Avoid secondhand smoke

4. Treat underlying allergy if present
   

Indications for Tympanostomy Tubes

• Bilateral OME ≥ 3 months + documented hearing loss

• Recurrent AOM:

  • ≥3 episodes in 6 months

  • OR ≥4 in 1 year (1 in past 6 months)

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🧠 Quick Mnemonics

AOM diagnosis mnemonic — “BAR”

• Bulging TM

• Acute symptoms (pain, fever)

• Reduced mobility

OME management mnemonic — “WHEAT”

• Watchful waiting

• Hearing test if >3 months

• Evaluate for risk factors

• Avoid unnecessary antibiotics

• Tympanostomy tubes (if hearing issue >3 months)