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(Photo contributor: Sydney C. Butts, MD)

*The authors acknowledge the special contributions of Anita Konka, MD, Matthew Hanson, MD, Miguel Mascaro, MD, Michael C. Singer, MD, Christina DiLoreto, MD, David H. Burstein, MD, Perminder S. Parmar, MD, Marika Fraser, MD, Haidy Marzouk, MD, Jessica W. Lim, MD, and Nur-Ain Nadir, MD, to prior edition.


Clinical Summary

Acute otitis media (AOM) is defined as the rapid onset of signs and symptoms of inflammation in the middle ear. AOM is considered highly likely if distinct bulging of the tympanic membrane (TM) or acute purulent otorrhea (not caused by acute otitis externa [AOE]) is seen. AOM is considered possible with mild bulging of the TM with recent onset of otalgia plus opacification, distinct erythema, or reduced mobility (on pneumatic otoscopy). AOM is considered unlikely with findings of middle-ear effusion without bulging or distinct erythema of the TM (eg, otitis media with effusion). Otalgia or other nonspecific symptoms (eg, fever, irritability) without middle-ear effusion or a bulging TM are not consistent with the diagnosis of AOM.

It can be difficult to fully visualize the TM to make the diagnosis; obstructing cerumen can be gently removed with suction or curettage either by ED staff or by the otolaryngology team. AOM should not be diagnosed empirically when the TM is poorly visualized.

Emergency Department Treatment and Disposition

Adequate pain relief is an essential part of management, especially in the first 24 hours after AOM diagnosis. Acetaminophen or ibuprofen is recommended; narcotics are rarely necessary and should be avoided. Antibiotics do not reduce pain associated with AOM in the first 24 to 48 hours and should not be used for this purpose. Topical analgesic drops typically containing benzocaine provide mild pain relief for 20 to 60 minutes after administration and may be useful between administration of oral analgesics and onset of pain relief. Topical analgesic drops should not be used if the TM is perforated or a tympanostomy tube is in place.


Normal Tympanic Membrane. Normal tympanic membrane in a neutral position without middle-ear effusion. (Photo contributor: Richard Rosenfeld, MD.)


Acute Otitis Media. Distinct bulging of the tympanic member with purulent middle-ear effusion consistent with acute otitis media. (Photo contributor: Richard Rosenfeld, MD.)


Otitis Media with Effusion. Nonbulging tympanic membrane with middle-ear effusion consistent with otitis media with effusion. (Photo contributor: Richard Rosenfeld, MD.)


Acute Otitis Media Presenting with Otorrhea. Purulent drainage from the external auditory canal (EAC). Various ...

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