Acute Otitis Media

Essentials of Diagnosis

• Otalgia.
  
• Pyrexia.
  
• Thickened, bulging, hyperemic tympanic membrane.
  
• Hearing loss.
  
• ± Otorrhea.
  

Symptoms and Signs

Prior to the onset of symptoms of AOM, the patient frequently has symptoms of an upper respiratory tract infection. Older children will usually complain of earache, whereas infants become irritable and pull at the affected ear. A high fever is often present and may be associated with systemic symptoms of infection, such as anorexia, vomiting, and diarrhea. Otoscopy classically shows a thickened hyperemic tympanic membrane, which is immobile on pneumatic otoscopy.

Further progression of the infective process may lead to the spontaneous rupture of the tympanic membrane, resulting in otorrhea. If this occurs, the otalgia and fever often subside. At this stage, it is often not possible to visualize the tympanic membrane due to the discharge in the ear canal.