JAMA PEDIATRICS PATIENT PAGE

Acute Otitis Media

Ear infections are common in young children.

The terms that health care professionals use to describe children’s Acute otitis media (AOM) is an ear infection
Middle ear
ear conditions can be confusing. There are 3 common terms. that occurs when fluid in the middle ear (behind the
eardrum) becomes trapped and infected.
(1) Acute otitis media (AOM) is the term used for middle ear infec-
MIDDLE EAR
tions. (2) Otitis media with effusion occurs when there is fluid in AOM INFECTION

the middle ear space that is not infected. This does not require Infected fluid
antibiotics. (3) Otitis externa is an infection of the space outside of Eardrum
the eardrum and involves the ear canal. Sometimes, this condition Eustachian tube
is known as swimmer’s ear.
Acute otitis media is one of the most common illnesses evalu-
AOM is diagnosed by using an Bulging eardrum
ated by pediatricians. About 50% of all children will have at least
otoscope to view the eardrum. Blocked eustachian tube
1 ear infection by the time they reach their second birthday. The most
common age range in which children are likely to get AOM is 3 to An upper respiratory tract infection (common cold) can cause the eustachian
tube to be blocked, trapping fluid in the middle ear and causing AOM infection.
24 months.
Acute otitis media is often related to a current or recent upper
bulging, which describes how the infected fluid is pushing on the
viral respiratory tract infection, also known as a common cold. This
eardrum. Other ways to tell that your child has AOM is by seeing
is because the upper respiratory tract infection can lead to prob-
pus draining from the eardrum and from seeing the appearance of
lems with the eustachian tube. The eustachian tube is a passage that
pus behind the eardrum.
connects and allows air to pass between the sinuses and the middle
If your child has AOM, they typically need an antibiotic medi-
ear space. When a child has an upper respiratory tract infection
cine to treat the infection, especially if they are 2 years or younger.
caused by a virus, it is common for the eustachian tube to become
It is important that the correct antibiotic is chosen for your child’s
plugged with fluid or mucus from the infection. When the eusta-
ear infection. Your child should complete all of the prescribed anti-
chian tube does not work well, fluid can get trapped in the middle
biotic medicine. Your child’s symptoms, such as ear pain, will usu-
space of the ear and become infected. Other risk factors for AOM
ally begin to improve in 2 to 3 days. Sometimes, your child’s physi-
include tobacco smoke exposure, day care attendance, family his-
cian may propose waiting to see if symptoms improve before starting
tory of AOM, and atopy (such as eczema, asthma, and seasonal
to take the antibiotics.
allergies). Breastfeeding and the absence of tobacco exposure has
It is very important that your child receives the right type of pain
been shown to be protective for the development of AOM.
management such as over-the-counter medicines to help with their
Symptoms of AOM vary and can depend on the age and devel-
ear infection pain. Pediatricians should also make sure that your child
opmental status of the child. The most specific symptom is ear pain.
can access a physician especially throughout the next few days
This pain is usually sudden and severe. It often wakes up the infant
after they have been diagnosed with an ear infection.
or young child during sleep. However, symptoms alone cannot be
used to diagnose AOM.
Your child’s physician can make the diagnosis of AOM only by FOR MORE INFORMATION
using a device called an otoscope to look at the ear. They will need Causes of earaches and ear infections:
to be able to properly view the eardrum to see if an infection is pres- https://www.healthychildren.org/English/tips-tools/symptom-
ent. In most cases of AOM, the shape of the eardrum will be checker/Pages/symptomviewer.aspx?symptom=Earache
abnormal. The medical term for this shape is that the eardrum is

Authors: Caroline R. Paul, MD; Megan A Moreno, MD, MSEd, MPH
Published Online: January 27, 2020. doi:10.1001/jamapediatrics.2019.5664
Author Affiliations: Department of Pediatrics, University of Wisconsin–Madison,
Madison.
Conflict of Interest Disclosures: None reported.
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