Acute Otitis Media

Definition
Acute otitis media (AOM) is an infection of the middle ear. It does not affect the ear canal;
however, infectious material may be present if tympanic perforation has occurred.
Etiology and Pathophysiology
1. Most episodes begin with viral upper respiratory tract infection (URI). Mucous membrane
edema results in occlusion of the eustachian tube, causing fluid accumulation in the middle ear.
This fluid may then become superinfected with bacteria.
2. The most common bacterial pathogens include:
a. Streptococcus pneumoniae
b. Moraxella catarrhalis
c. Haemophilus influenzae
d. Group A beta-hemolytic streptococci
Associated Clinical Features
1. Vertigo and hearing impairment are uncommon but result from vestibulocochlear
involvement.
2. Other findings may include those associated with primary viral infection (e.g., fever,
lymphadenopathy, rhinorrhea).
3. The diagnosis is clinical (although there are several diagnostic adjuncts, such as reflex
tympanography, which may be used).

Complications
1. Mastoiditis
2. Bacteremia
3. Sepsis
4. Tympanic membrane perforation
5. Cholesteatoma
6. Facial paralysis
7. Intracranial suppurative complications (e.g., meningitis, brain abscess, encephalitis)