Acute Otitis Media (AOM) in Children

  • Less than 6 months of age

  • Craniofacial abnormalities

  • Immunosuppressed patients

  • Presence of tympanostomy tubes

  • Recurrent AOM

    • 3 or more episodes of AOM in a 6-month period OR 4 or more episodes of AOM in a 12-month period (with at least one episode in the last 6 months)
    • These patients may benefit from an ENT referral

Diagnosis

Accurate diagnosis of AOM is the cornerstone of management. The diagnosis of AOM requires the 3 criteria below:

  • Symptoms can be non-specific, especially in pre-verbal children.

  • Symptoms can include, but are not limited to: otalgia (or ‘suspected’ otalgia), fever, crying, irritability, difficulty sleeping, decreased playfulness

  • Tugging/rubbing of the ear can be present in AOM; however, it can also be due to other causes (such as viral infections)

  • Loss of bony landmarks; OR

  • The presence of an air-fluid level on the tympanic membrane; OR

  • Little or no mobility of the tympanic membrane using a pneumatic otoscope.

  • Bulging tympanic membrane (diagnosis is strengthened by findings of distinct/intense erythema, hemorrhagic patches, and the presence of yellow/cloudy fluid).

  • Acute tympanic membrane perforation

Treatment Criteria and Considerations

AOM should be differentiated from OME, as the management of OME does NOT require antibiotics

  • Adequate analgesia is an essential component of management of AOM

  • Recommend ibuprofen (preferred) and/or acetaminophen as needed for pain

    • Ibuprofen 10 mg/kg/dose PO q6-8h PRN (max 40 mg/kg/day)
    • Acetaminophen 10-15 mg/kg/dose PO q4h PRN (max 75 mg/kg/day)

To help prevent AOM:

  • Hand hygiene

  • Pneumococcal vaccination

  • Yearly influenza vaccination

  • Encourage exclusive breastfeeding for at least 6 months

  • Encourage avoidance of tobacco smoke

  • Avoid supine bottle feeding

  • Reduce or eliminate pacifier use in children older than 6 months

Definitions

ALL of the following:

  • Unilateral AOM

  • Feeding and/or sleeping well

  • Alert

  • Responding well to analgesia

  • Oral temperature <39ºC

    • Rectal and tympanic temperature is approximately 0.3 to 0.6 °C HIGHER than oral temperature
    • Axillary temperature is approximately 0.3 to 0.6 °C LOWER than oral temperature
  • Illness lasting <48 hours

AT LEAST 1 of the following:

  • Bilateral AOM

  • Difficulty feeding or sleeping

  • Severe pain

  • Oral temperature of ≥39ºC

    • Rectal and tympanic temperature is approximately 0.3 to 0.6 °C HIGHER than oral temperature
    • Axillary temperature is approximately 0.3 to 0.6 °C LOWER than oral temperature
  • Illness lasting >48 hours

  • Tympanic membrane perforation

After 2-3 days of appropriate therapy

More Information

Guideline content derived from:

  • NB Provincial Health Authorities Anti-Infective Stewardship Committee. Antimicrobial Therapy for Acute Otitis Media (AOM) in Children. 2020

  • IWK Health Centre (Spectrum)

  1. N Le Saux, JL Robinson; Canadian Paediatric Society, Infectious Diseases and Immunization Committee. Management of acute otitis media in children six months of age and older. Paediatr Child Health 2016;21(1):39-50.
  2. Liberthal AS et al; American Academy of Pediatrics. The Diagnosis and Management of Acute Otitis Media. Pediatrics. 2013; 131 (3): e964-e999
  3. Sakulchit T & Goldman RD. Antibiotic therapy for children with acute otitis media. Canadian Family Physician. 2017; 63 (9): 685-687
  4. IWK. Acute Otitis Media Guidelines. Accessed via mobile app. 06-2019
  5. Bugs & Drugs. Accessed via mobile app. 06-2019