Examqo › Examqo library › Pediatrics › Paediatric infectious disease · IMLE
Acute otitis media (AOM)
The diagnosis rests on a bulging tympanic membrane or new otorrhoea, not on redness alone; whether to treat at once or observe depends on age, severity and whether the disease is unilateral or bilateral.
Why it matters in the exam
This is the most common diagnosis for which children receive antibiotics, so questions focus on three decision points: is this AOM at all (versus effusion without inflammation — OME), may the child be observed for 48–72 hours, and which drug to give. A standard distractor is a red eardrum in a crying or febrile infant, which is not enough for the diagnosis.
Amoxicillin 80–90 mg/kg per day in two doses is first-line. Switch to amoxicillin-clavulanate if the child received amoxicillin in the last 30 days, has purulent conjunctivitis (the otitis-conjunctivitis syndrome of non-typeable H. influenzae) or has recurrent AOM unresponsive to amoxicillin. After 48–72 hours of failure, reassess and change to amoxicillin-clavulanate or ceftriaxone 50 mg/kg by injection for one to three days.
Also examined are treatment duration by age (10 days under 2 years, 7 days at 2–5 years, 5–7 days from age 6 in mild to moderate disease), the indications for tympanostomy tubes, and complications — mainly mastoiditis with a protruding auricle and tender swelling behind the ear, and facial nerve palsy. OME after AOM is common and is not treated with antibiotics.
Key points
- Diagnosis: a bulging eardrum or new otorrhoea, not redness alone.
- Under 6 months always treat; over 2 years with non-severe disease, observation is possible.
- Amoxicillin 80–90 mg/kg per day is first-line.
- Amoxicillin-clavulanate: amoxicillin in the last 30 days or purulent conjunctivitis.
- OME — watchful waiting; tubes for persistent effusion with hearing loss or recurrent AOM.
Summary table
| Situation | Definition | Approach | Note |
|---|---|---|---|
| AOM under 6 months | Any AOM | Antibiotics at once | No observation option |
| Age 6–23 months | Bilateral or severe versus unilateral non-severe | Bilateral or severe → antibiotics; unilateral non-severe → antibiotics or observation | Severe: temperature 39°C or more, moderate to severe pain, or pain for more than 48 hours |
| Age 24 months and older | Severe versus non-severe | Severe → antibiotics; non-severe → antibiotics or observation for 48–72 hours | Observe only when follow-up is assured |
| OME | Effusion without signs of acute inflammation | Watchful waiting for 3 months, hearing test if it persists | No antibiotics and no steroids |
| Recurrent AOM | 3 episodes in 6 months or 4 in a year with one in the last 6 months | Consider tympanostomy tubes when effusion is present | Not antibiotic prophylaxis |
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
The full version is open to subscribers of: Pediatrics, Medical licensing exam (IMLE), Family medicine, ENT and head and neck surgery.
Subscriber? Read the full topic Plans and prices 25 free questions
Sources
- AAP Clinical Practice Guideline: The Diagnosis and Management of Acute Otitis Media, 2013 — Diagnosis, observation option and antibiotic choice
- AAO-HNSF Clinical Practice Guideline: Otitis Media with Effusion (Update), 2016 — Watchful waiting and tympanostomy tubes
- Nelson Textbook of Pediatrics, 22nd edition (2024) — Otitis Media
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.