Otology A18


Acute otitis media (child)

Tympanic membrane perforation is a common complication of acute otitis media (AOM). In a study undertaken to define the characteristics of spontaneous eardrum perforation in acute otitis media, the perforation spontaneously closed in 94% of the patients within one month. 

AOM is usually managed conservatively, with appropriate analgesia, since the majority of cases are viral and improve without antibiotics. Antibiotics make little difference to the number of children with recurrent infections, short-term hearing loss or perforated ear drum.

Oral antibiotics may be considered if:

  • No improvement within 72 hours of symptom onset
  • Systemically very unwell
  • Otorrhoea
  • Age <2 years old with bilateral infection

Admit for immediate specialist assessment if:

  • Severe systemic infection
  • Suspected acute complications of AOM (meningitis, mastoiditis, intracranial abscess, sinus thrombosis, or facial nerve paralysis)
  • Age < 3 months with pyrexia

Correct Answer: