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A 15-month-old boy is brought by both parents to his family physician with a 2-day history of fever, irritability, and frequent tugging of his left ear. This was preceded by a 1-week history of nasal congestion, cough, and rhinorrhea. On otoscopy, his left tympanic membrane (TM) appears erythematous, cloudy, bulging, and exudative (Figure 28-1). His left TM fails to move on pneumatic otoscopy. The physician diagnoses acute otitis media and decides with the parents to prescribe a 10-day course of amoxicillin; the child recovers uneventfully.


Acute otitis media in the left ear of a 15-month-old patient with marked erythema and bulging of the tympanic membrane. The malleus and light reflex are not visible. (Reproduced with permission from William Clark, MD.)

In follow-up 2 months later, the child appears healthy and is meeting all his developmental milestones. On otoscopic examination, air–fluid levels are seen in the right ear (Figure 28-2). The physician explains the diagnosis of otitis media with effusion to the parents and arranges follow-up. Three months later, the effusion is completely resolved.


Otitis media with effusion (OME) in the right ear. Note multiple air–fluid levels in this slightly retracted, translucent, nonerythematous tympanic membrane. (Reproduced with permission from Frank Miller, MD.)


Acute otitis media (AOM) is the most common diagnosis for acute office visits for children.1 AOM is characterized by middle-ear effusion in a patient with signs and symptoms of acute illness (e.g., fever, irritability, otalgia). Otitis media with effusion (OME) is a disorder characterized by fluid in the middle ear in a patient without signs and symptoms of acute ear infection; it is also very common in childhood.


  • AOM: acute suppurative, purulent, or bacterial otitis media.2

  • OME: glue ear; secretory, nonsuppurative, serous, or mucoid otitis media.2


  • AOM accounted for $5 billion of the total national health expenditure in 2000; more than 40% was incurred for children between 1 and 3 years of age.1

  • It is estimated that 60% to 80% of children in the United States develop AOM by 1 year of age and that 80% to 90% develop AOM by 2 to 3 years of age.3,4

  • The highest incidence occurs between 6 and 24 months of age.3,4

  • AOM is the most common reason for outpatient antibiotic treatment in the United States.5 A national survey in 1992 revealed that 30% of all antibiotics prescribed for children younger than age 18 years was for treatment of AOM.6

  • In the United Kingdom, 87% of AOM cases receive antibiotics.7

  • OME is ...

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