Acute Otitis Media

What this deck covers

Acute Otitis Media in ten clinical teaching cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong.

Diagnoses and management options tested

Across the ten cases you are asked to choose between options such as: Otitis media with effusion (OME), Acute otitis externa, Acute otitis media (AOM), Eustachian tube dysfunction, Erythema of the tympanic membrane, Loss of the light reflex, Bulging of the tympanic membrane, Opacification of the tympanic membrane, Immature cochlear hair cells allowing bacterial invasion, Congenital abnormality of the tympanic membrane, Tympanocentesis for culture, Chronic suppurative otitis media, Immediate amoxicillin 90 mg/kg/day for 10 days, Immediate azithromycin for 5 days.

Clinical pearls from this deck

• AOM requires acute onset + signs of middle-ear effusion (bulging TM and/or reduced mobility on pneumatic otoscopy) + signs of middle-ear inflammation (erythema, otalgia/ear-pulling, fever). A bulging TM is the single most predictive finding. OME has effusion without acute inflammation; otitis externa involves the ear canal, not the middle ear.
• Bulging of the TM has the highest specificity and positive predictive value for AOM. Erythema alone is non-specific — crying, fever, or cerumen removal can redden the drum. Loss of the light reflex and opacification are supportive but less specific than bulging.
• The pediatric Eustachian tube is shorter, wider, and more horizontal, so a viral URI causes mucosal edema → tubal obstruction → negative middle-ear pressure → effusion → bacterial ascent from the nasopharynx. The three classic pathogens are S. pneumoniae, non-typeable H. influenzae, and M. catarrhalis.
• AOM is a clinical diagnosis; pneumatic otoscopy is the gold standard. Tympanometry helps only when otoscopy is equivocal. Tympanocentesis (for culture) is reserved for treatment failure, toxic-appearing or immunocompromised children, and neonates — not routine confirmation.
• OME (“glue ear”) = middle-ear effusion without acute inflammation: a retracted/neutral, amber TM with air-fluid levels, reduced mobility, and conductive hearing loss — but no fever or otalgia. Most resolve spontaneously, so watchful waiting (~3 months) is standard. Cholesteatoma would show keratin debris or a retraction pocket.
• For a healthy child ≥2 years with non-severe, unilateral AOM (mild otalgia observation option with a safety-net (delayed) prescription is appropriate — fill only if no improvement or worsening within 48–72 h. If antibiotics are chosen, first-line is high-dose amoxicillin, not azithromycin (high pneumococcal macrolide resistance).
• Failure after 48–72 h of high-dose amoxicillin implies beta-lactamase–producing organisms (H. influenzae, M. catarrhalis) or resistant S. pneumoniae — escalate to high-dose amoxicillin-clavulanate. Azithromycin is not appropriate for failure; tympanocentesis is reserved for failure of second-line therapy or toxic/immunocompromised children.
• Acute mastoiditis is the most common suppurative complication of AOM. Classic signs: postauricular erythema, tenderness, and swelling with the auricle pushed forward and downward. It needs urgent temporal-bone CT, IV antibiotics, and ENT consultation; other AOM complications include meningitis, brain abscess, labyrinthitis, and facial nerve palsy.
• Recurrent AOM = ≥3 episodes in 6 months, or ≥4 in 12 months with ≥1 in the past 6 months — this child meets both. Tympanostomy tubes have the strongest evidence to reduce episode frequency once criteria are met. Antibiotic prophylaxis is no longer recommended (resistance, modest benefit).

The deck above is free and needs no sign-in. Work through it once for recognition, then again a week later to test yourself — each question has one best answer and a worked explanation.

More from this system: all ent decks and question sets · pediatric reference values.