Otitis media is a general term used to describe inflammation of the middle ear which may be caused by an acute infection.
The symptoms are usually nonspecific and include otalgia (pulling of ear in an infant), irritability, otorrhea with or without fever.
Symptoms of upper respiratory tract infection may also be present.


  • Diagnosis of acute otitis media (AOM) requires a history of acute onset of signs & symptoms, signs & symptoms of middle ear inflammation, & confirmation of middle ear effusion (MEE)


  • History alone is a poor predictor of the presence of acute otitis media (AOM)
  • Signs & symptoms are usually nonspecific
  • Viral upper respiratory tract infection (URTI) symptoms may be present before or during AOM

Physical Examination

Presence of middle ear effusion (MEE)

  • MEE can be confirmed by direct visualization of the tympanic membrane by otoscopy or pneumatic otoscopy
  • Presence of MEE is indicated by any of the following:
    • Bulging tympanic membrane w/ loss of normal landmarks
    • Opacification or cloudiness of tympanic membrane
    • Absent or limited mobility of tympanic membrane w/ pneumatic pressure
    • Otorrhea (positive purulence is associated w/ rupture of tympanic membrane)
    • Air-fluid level behind the tympanic membrane
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