Acute Otitis Media


Your sweet-natured infant erupts in a fit of fussiness and intense crying. Your toddler clutches her ear while wincing in pain. Your older child complains about a pain in his ears. For children, these behaviors often mean they have acute otitis media. Acute otitis media (AOM) is a type of ear infection. It is a short and painful ear infection in which the middle ear, located behind the eardrum, becomes inflamed and infected.

What Causes Acute Otitis Media?

An AOM occurs when your child’s eustachian tube (the tube that runs from the middle of the ear to the back of the throat) becomes swollen or blocked and traps fluid in the middle ear. The trapped fluid can become infected. In young children, the Eustachian tube is shorter and more horizontal than it is in older children and adults, making it more vulnerable to infection.

The Eustachian tube can become swollen or blocked for several reasons:

  • allergies
  • cold or flu
  • sinus infections
  • infected or enlarged adenoids
  • cigarette smoke
  • in infants, drinking while laying down

Who Is at Risk for Acute Otitis Media?

Risk factors for acute otitis media include:

  • being between six months and 36 months old
  • using a pacifier
  • attending daycare
  • being bottle fed instead of breastfed (infants)
  • drinking while laying down (infants)
  • recent cold, flu, or sinus infection
  • recent ear infection
  • exposure to cigarette smoke
  • exposure to high-levels of air pollution
  • changes in altitude
  • changes in climate
  • cold climate
  • genetics

What are the Symptoms of Acute Otitis Media?

Infants and children may have one or more of the following symptoms:

  • crying
  • irritability
  • sleeplessness
  • pulling on the ears
  • ear pain
  • headache
  • neck pain
  • a feeling of fullness in the ear
  • fluid drainage from the ear
  • fever
  • vomiting
  • diarrhea
  • irritability
  • lack of balance
  • hearing loss

How Is Acute Otitis Media Diagnosed?

Your child’s doctor may use one or more of the following methods to diagnose AOM:


Your doctor uses an instrument called an otoscope to look into your child’s ear and detect redness, swelling, blood, pus, air bubbles or fluid in the middle ear. An otoscope can also detect a perforation in the eardrum.


A tympanometry test uses a small instrument to measure the air pressure in your child’s ear to determine if the eardrum is ruptured.


A reflectometry test uses a small instrument that makes a sound near your child’s ear. Your doctor can determine if there is fluid in the ear by listening to the sound reflected back from the ear.

Hearing Test

Your doctor may perform a hearing test to determine if you are experiencing hearing loss.

How Is Acute Otitis Media Treated?

The majority of acute otitis media infections resolve without antibiotic treatment. To avoid the overuse of antibiotics and reduce the risk of adverse reactions caused by antibiotics, home treatment and pain medications are usually tried before antibiotics are recommended. Treatments for acute otitis media include:

Home Care

Your doctor may suggest the following home care treatments to relieve your child’s pain, while waiting for the AOM infection to go away:

  • applying a warm, moist washcloth over your infected ear
  • using over-the-counter pain relieving ear drops
  • taking over-the-counter pain relievers such as Advil, Tylenol, or Motrin


Your doctor may prescribe prescription strength pain relieving eardrops and pain relievers. Your doctor may also prescribe antibiotics if your symptoms do not go away after a few days of home treatment. In some cases, your doctor may prescribe them along with antibiotics.


If your child’s infection does not respond to treatment or if your child has recurrent ear infections, your doctor may recommend surgery. Surgery options for acute otitis media include:

Adenoid Removal

Your child’s doctor may recommend that the adenoids be surgically removed if they are enlarged or infected, and your child has recurrent ear infections.

Ear Tubes

Your doctor may suggest a surgical procedure to insert tiny tubes in your child’s ear. The tubes allow air and fluid to drain from the middle ear.

What is the Long Term Outlook?

Acute otitis media infections generally get better without any complications, but the infection may recur. Your child may also experience temporary hearing loss for a short time. But your child’s hearing should return quickly after treatment. Sometimes, acute otitis media infections can cause:

  • recurrent ear infections
  • enlarged adenoids
  • enlarged tonsils
  • a ruptured eardrum
  • a growth in the middle ear (called cholesteatoma)
  • speech delays in children who have recurrent otitis media infections
  • in rare cases, an infection in the mastoid bone in the skull (called mastoditis)
  • in rare cases, an infection in the brain (meningitis)

How to Prevent Acute Otitis Media

You can reduce the chances of your child having AOM by doing the following:

  • wash hands and toys frequently to reduce your chances of getting a cold or other respiratory infection
  • avoid cigarette smoke
  • get seasonal flu shots and pneumococcal vaccines
  • choose breastfeeding instead of bottle feeding for infants
  • do not give your infant a pacifier

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