Understanding Acute Otitis Media (AOM): Etiology, Clinical Features, and Management

Introduction

Acute Otitis Media (AOM) is a common middle ear infection predominantly affecting infants and young children. This blog post explores the etiology, pathogenesis, clinical presentation, and evidence-based treatment modalities of AOM within the scope of otorhinolaryngology.

Etiology

AOM commonly results from viral upper respiratory tract infections that facilitate bacterial colonization of the middle ear. The most frequently isolated pathogens include:

• Streptococcus pneumoniae
• Haemophilus influenzae (non-typable)
• Moraxella catarrhalis

Pathogenesis

The pathogenesis of AOM involves Eustachian tube dysfunction leading to impaired ventilation, negative middle ear pressure, and subsequent effusion. Viral-induced mucosal inflammation fosters bacterial superinfection, resulting in purulent middle ear fluid.

Clinical Features

• Otalgia (ear pain)
• Fever
• Otorrhea (in cases with tympanic membrane perforation)
• Irritability and feeding difficulties in infants
• Bulging and erythematous tympanic membrane on otoscopy

Diagnosis

Diagnosis is primarily clinical, based on otoscopic examination. Pneumatic otoscopy or tympanometry may support the diagnosis by assessing tympanic membrane mobility and middle ear effusion.

Management

Pharmacological Treatment

• First-line therapy: Amoxicillin 80–90 mg/kg/day in divided doses
• Second-line: Amoxicillin-clavulanate or a cephalosporin in case of resistance or penicillin allergy
• Antipyretics and analgesics (e.g., acetaminophen, ibuprofen) for symptomatic relief

Watchful Waiting

In select patients with mild symptoms and age over 2 years, observation for 48–72 hours without immediate antibiotics may be considered.

Surgical Intervention

• Myringotomy: Considered in cases with severe pain or complications
• Tympanostomy tubes: For recurrent AOM (≥3 episodes in 6 months or ≥4 in 1 year)

Prevention

• Vaccination against pneumococcus and influenza
• Breastfeeding for at least six months
• Minimizing pacifier use and tobacco smoke exposure

Conclusion

Prompt recognition and appropriate management of AOM are essential to prevent complications such as hearing loss and mastoiditis. Clinicians must tailor treatment based on age, severity, and recurrence risk while promoting preventive strategies.