In this section
Sepsis assessment and management
Acute otitis media (AOM) is a common problem in early childhood
Causes of acute otitis media are often multifactorial. Exposure to cigarette smoke from household contacts is a known modifiable risk factor.
Features: recent onset ear pain (irritability in pre-verbal children), fever, anorexia, vomiting, lethargy.
Signs of acute inflammation of the tympanic membrane (TM)
Normal Tympanic Membrane
Pink Tympanic Membrane, often seen with fever or upper respiratory tract infections
Bulging and erythematous Tympanic Membrane in AOM
Otitis Media with Effusion "glue ear"
Do not attempt removal of wax from the ear canals to assess for acute otitis media as it is unlikely to alter management.
There is no role for routine diagnostic investigation for AOM.
Symptomatic treatment with adequate and regular analgesia is very important. See
Most cases of AOM in children resolve spontaneously. The routine use of antibiotic treatment should be avoided.
<6 months old, including neonates: AOM is difficult to ascertain, and other diagnoses should be fully considered (see Febrile child).
Infants 3-6 months of age: clear diagnosis of AOM and systemically well - manage as per flowchart below. Otherwise see
AOM with TM perforation is common and results in otorrhoea and frequently, relief of pain. TM perforation does not alter AOM management (see flowchart).
Acute mastoiditis, although rare, is the most common suppurative complication of AOM and may be associated with intracranial complications.
Acute mastoiditis: post auricular inflammatory signs (erythema/swelling/pain) and protruding auricle.
Otitis media with effusion, previously termed serous otitis or glue ear, is fluid in the middle ear without signs and symptoms of infection and is often asymptomatic, other than transient hearing impairment
Antibiotics and ENT referral are not routinely required for OME, as the majority of cases occur after an episode of AOM and resolve spontaneously with no long term effects on language, literacy or cognitive development.
Persistent effusion beyond 3 months should trigger a hearing assessment and ENT involvement/referral.
Children who are systemically unwell
Children with acute mastoiditis or a cochlear implant should be discussed with ENT
Children requiring care beyond the level of comfort of the local hospital.
For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.
Adequate pain relief attainable
No signs of complications
Last Updated April 2018