İşitmeAtölyesiAt a glance
Sudden-onset inflammation of the middle-ear mucosa, most often following an upper respiratory infection.
Ear pain (otalgia), fever, irritability, tugging at the ear, reduced hearing; discharge if the drum perforates.
Prompt assessment is needed in a febrile infant under 3 months and in a severe picture.
Pain control in all cases; 48-72 hours of observation in selected children, antibiotics if needed.
Medical disclaimer. This content is for informational purposes only and does not replace a physician’s examination, diagnosis or treatment; it should not be used as medical advice. For your complaints or personal situation, always consult an ear, nose and throat physician and an audiologist.
If a febrile infant under 3 months is irritable, if the child’s general condition is poor, if symptoms do not improve within 48-72 hours, or if ear discharge begins, see a physician. Dizziness, facial palsy or swelling/redness behind the ear require emergency assessment.
Definition and epidemiology
Acute otitis media (AOM) is a sudden-onset inflammation of the middle-ear mucosa, most often following an upper respiratory infection. It is characterised by bulging and redness of the eardrum and fluid in the middle ear.
It is one of the most common bacterial infections of childhood; most children have at least one episode by age 3. It is most frequent between 6 months and 2 years (Lieberthal et al., 2013).
In children the Eustachian tube is shorter and more horizontal, which makes it easy for microorganisms in the nasopharynx to reach the middle ear.
Symptoms and signs
In infants and young children symptoms may be non-specific: irritability, tugging at the ear, disturbed sleep and appetite, fever. In older children ear pain (otalgia) and reduced hearing are prominent.
If the eardrum perforates, the pain may suddenly ease and discharge may come to the ear canal; although this relieves the picture, it indicates the severity of the infection.
In infants under 3 months, AOM with fever requires more careful assessment for systemic infection.
Causes and risk factors
The most common agents are Streptococcus pneumoniae, non-typeable Haemophilus influenzae and Moraxella catarrhalis. Although pneumococcal vaccines (PCV) reduce invasive disease, serotypes outside the vaccine coverage continue to cause AOM (Kaur et al., 2017).
Risk factors include not receiving breast milk in the first 6 months, bottle-feeding while lying down, daycare settings, passive smoke, pacifier use and crowded living.
Conditions such as cleft palate and Down syndrome facilitate recurrent episodes because of Eustachian dysfunction.
Audiological and clinical assessment
Diagnosis is basically clinical: sudden onset, evidence of middle-ear fluid and signs of inflammation in the drum are sought together. Redness alone is not enough for diagnosis; bulging of the drum is the most specific finding.
- Pneumatic otoscopy: assesses eardrum mobility; shows middle-ear fluid.
- Tympanometry: objectively supports the presence of fluid.
- Probe tone: a 1000 Hz probe tone is required in infants under 6 months; the standard 226 Hz can give a misleading ‘normal’.
- Hearing assessment: an age-appropriate hearing test is planned in recurrent cases or when the effusion is prolonged.
Audiological assessment is important, especially in children with frequent recurrences and prolonged effusion, to protect hearing and language development.
Treatment and audiological rehabilitation
In children over 2 who are in good general condition with mild symptoms, a 48-72 hour observation (watchful waiting) approach may be appropriate; many cases resolve without antibiotics. Pain control (paracetamol/ibuprofen) is important in all cases (Venekamp et al., 2015).
If there is an indication for an antibiotic, the first choice is usually amoxicillin at an appropriate dose; with suspicion of a resistant pathogen, amoxicillin-clavulanate is used. The decision and dosing are made by the physician.
In recurrent AOM (3 episodes in 6 months or 4 in 12 months) or accompanying persistent effusion, a ventilation tube and, where needed, adenoidectomy are considered. If a permanent hearing loss develops, audiological rehabilitation is planned.
Impact on quality of life and advice
Frequent episodes can disrupt the child’s sleep and feeding and the family’s routine. Recurrent, untreated effusions can affect language development through fluctuating hearing.
Breast milk, keeping away from smoke, completing vaccinations and not bottle-feeding while lying down reduce episodes. If symptoms are severe or prolonged, it is important to see a physician.
If you used this review, you can cite it as follows (APA 7):
İşitme Atölyesi. (2026). Acute Otitis Media. Hearing & Balance Health Guide. https://www.isitmeatolyesi.com/en/guncel-haberler/categories/isitme-sagligi-rehberi/akut-otitis-media/Permanent link: isitmeatolyesi.com/en/guncel-haberler/categories/isitme-sagligi-rehberi/akut-otitis-media/ · Last reviewed: July 2026 · License: CC BY-NC-ND 4.0
References
- Kaur, R., Morris, M., & Pichichero, M. E. (2017). Epidemiology of acute otitis media in the postpneumococcal conjugate vaccine era. Pediatrics, 140(3), e20170181.
- Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., et al. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), e964-e999.
- Venekamp, R. P., Sanders, S. L., Glasziou, P. P., Del Mar, C. B., & Rovers, M. M. (2015). Antibiotics for acute otitis media in children. Cochrane Database of Systematic Reviews, 6, CD000219.
Frequently asked questions
Does every earache need an antibiotic?
No. In children over 2 who are in good condition, many episodes resolve on their own within 2-3 days; your physician may therefore first advise observation with a painkiller. The decision about antibiotics is based on the child’s age, symptom severity and examination findings.
Why does a fully vaccinated child get otitis media?
Pneumococcal vaccines cover some of the most common agents, but bacteria and viruses not in the vaccine continue to cause infection. So otitis media can occur in vaccinated children too; nonetheless, vaccines reduce severe and invasive disease.
The eardrum perforated; will hearing be permanently impaired?
Perforation due to acute inflammation usually heals on its own within a few weeks and hearing returns to normal. However, if the discharge is prolonged or the hole does not close, a check-up is needed.
Does middle-ear fluid permanently affect language development?
If the fluid lasts longer than 3 months or recurs often, it can make it harder for the child to hear sounds clearly. With early diagnosis, appropriate treatment and communication support, these effects are usually reversible.
Is a tube essential in recurrent infections?
A tube can be effective in reducing frequent episodes that affect hearing, but it is not needed in every child. The decision is made with the physician based on episode frequency, hearing status and any accompanying effusion.
Scales that can be used to monitor hearing/development impact in recurrent otitis and Eustachian function: