Acute otitis media (AOM)

This is for anyone looking after a baby or child with acute otitis media (AOM).

What is acute otitis media (AOM)?

The ear is formed of the external ear (ear canal), middle ear (the small bones and space behind the eardrum) and inner ear (responsible for perceiving sounds and balance).

AOM is an ear infection that affects the middle ear. It causes inflammation and a collection of fluid behind the eardrum (effusion). Healthcare professionals often call it ‘middle ear infection’.

AOM usually affects children, but adults can experience it too. It is often caused by a viral infection, but can be caused by bacteria as well.

AOM is different to otitis media with effusion (glue ear). This occurs when fluid collects behind the ear without any signs of infection.

What are the symptoms of AOM?

Common symptoms can include one or more of the following.

• earache, which may present as tugging, holding or rubbing the ear in younger children
• decreased hearing
• fever (temperature above 38 degrees C)
• discharge, fluid or bleeding from the affected ear (which can indicate a perforated eardrum)
• poor feeding
• restlessness or crying
• cough, runny nose or other cold-like symptoms
• on examination by a healthcare professional, a discoloured, cloudy or bulging ear drum may be seen using a special torch.

What are the treatments for AOM?

Most middle ear infections are mild and improve quickly without the need for treatment (usually within 3 to 7 days). If your child’s symptoms are mild, using painkillers like paracetamol (for example Calpol) or ibuprofen (for example Nurofen) can help to manage them. Read the instructions on the packet carefully, and never exceed the recommended dose.

If you have any concerns or you think your child is unwell, we recommend you book an appointment with your GP, who will assess whether a course of antibiotics is needed. Children with some underlying health conditions are more likely to need antibiotics. Ask your GP if you are unsure.

Your GP may prescribe an antibiotic if:

• your child has discharge from their ear
• your child has a high fever
• your child is under 2 years of age and appears to have an infection in both ears. 

What are the possible complications?

• Mastoiditis (an infection that affects the mastoid bone behind the ear). This is a rare but serious complication which often requires treatment in hospital. Symptoms include swelling and tenderness behind your child’s ear, neck stiffness, unusual sleepiness or agitation, and your child wanting to avoid bright light.
• Otitis media with effusion (glue ear) can develop. The main symptom is persistent reduced hearing. Make a GP appointment if you notice this.
• Perforated eardrum. This happens when a hole develops in the ear drum and fluid escapes. It often heals spontaneously. See your GP 6 to 8 weeks after first diagnosis to check that the eardrum has healed.

If you think your child is unwell, seek urgent medical attention by visiting your nearest Emergency Department (A&E) or calling 999.

Frequently asked questions

Is AOM contagious?	AOM is not considered contagious. However, it is caused by common viral throat and chest infections, which can be spread from person to person. Help reduce the spread of symptoms by using simple hand hygiene and covering the mouth and nose when coughing or sneezing.
Is school/nursery exclusion necessary?	Exclusion from school or nursery is not necessary. Make a decision based upon whether your child is generally well enough to attend.
Can my child fly with AOM?	Pain and damage to the ear can occur if your child flies with an ear infection. Your GP will not be able to give your child medical clearance to fly with an ear infection. Contact the relevant airline to ask if they will permit your child to travel.

More information

NHS information on ear infections: https://www.nhs.uk/conditions/ear-infections/

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Contacts

Your GP or local pharmacist
Paediatrics Admin Team: Monday to Friday, 9 am to 5 pm	020 8934 6403 khft.paediatricadmin@nhs.net