Etiology, Pathogenesis, Clinical Features, and Management of Acute Otitis Media (AOM)

Introduction

Acute Otitis Media (AOM) is one of the most common pediatric infections, primarily affecting infants and young children. It is characterized by middle ear inflammation often caused by bacterial or viral pathogens.

Etiology

AOM is commonly triggered by upper respiratory tract infections. The leading bacterial pathogens include:

• Streptococcus pneumoniae - Most frequently responsible
• Haemophilus influenzae - Associated with more severe cases
• Moraxella catarrhalis - Less common but still relevant

Pathogenesis

The infection occurs when pathogens travel from the nasopharynx to the middle ear via the Eustachian tube, leading to fluid accumulation and inflammation.

Clinical Features

• Fever
• Ear pain (otalgia)
• Irritability and crying in infants
• Hearing loss due to middle ear effusion
• Red and bulging tympanic membrane

Diagnosis and Differential Diagnosis

Diagnosis is primarily clinical, based on physical examination and otoscopic findings. AOM must be differentiated from:

• Otitis media with effusion (OME) – Lacks acute symptoms
• Mastoiditis – Postauricular swelling and pain
• Foreign body in the ear – Common in toddlers

Management

First-line Antibiotics

• Amoxicillin – Preferred choice
• Amoxicillin-clavulanate – Used in resistant cases

Symptomatic Treatment

• Analgesics such as ibuprofen or acetaminophen
• Hydration and rest
• Warm compresses

Prevention

• Vaccination (Pneumococcal, Influenza)
• Breastfeeding – Reduces risk
• Minimizing exposure to tobacco smoke