acute onset of either of the following signs of acute otitis media on examination:

• Bulging of the tympanic membrane (strongly suggestive of middle ear inflammation).
• Otorrhoea (indicative of tympanic membrane perforation and middle ear effusion, provided acute diffuse otitis externa has been excluded).

<aside> 💡 Pain alone is not sufficient for diagnosis of acute otitis media.

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Recurrent AOM:

• Occurrence of 3 episodes of AOM in 6-month period or 4 episodes in a year.
  • manage as acute OM and consider referral to an otolaryngologist. Frequent recurrences may require myringotomy and insertion of tympanostomy tubes (grommets).

Demographics

• children 6m-2y (infants have a wider, shorter and more horizontal ET + immature immune system).
• M > F.
• ATSI

Approx. 60–80% of children ≤ 3 years old experience AOM at least once. The incidence of AOM has been declining since the introduction of the pneumococcal and influenza vaccines.

Aetiology

• Viral: Adeno, echo & rhinoviruses
  • complication of common cold.
• Secondary bacterial infection by S. pneumoniae, H.influenza & Moraxella → pus.
• Repeated infection → chronic otitis media (Pseudomonas or Staph / fungus)

Risk factors

• Passive cigarette smoke.