Skip to main content

Otitis Media, Emergency Medicine

Assaad J. Sayah Reviewed 06/2017



  • Inflammation of the middle ear

  • Most commonly occurs in children 6–36 mo

  • Rapid onset of local and/or systemic symptoms

  • More than 1/3 of children experience >5 episodes by the age of 7...


From the American Academy of Pediatrics 2013 Guidelines: 
  • Diagnose otitis media (OM) when:

    • Moderate to severe bulging of tympanic membrane (TM)

    • Mild bulging of TM and recent onset of ear pain (...


Ed Treatment/Procedures

  • Most mild cases could resolve without antibiotics

  • Antibiotics are indicated for:

    • All infants <6 mo

    • Children <2 yr with bilateral OM

    • Bilateral OM in kids <2 yr

    • Chil...



Admission Criteria

Febrile toxic children who are: 
  • <1 yr, immunocompromised

  • Moderately or severely dehydrated

  • Unable to tolerate oral fluids or medications

  • Suspected or proven asso...

Pearls and Pitfalls

For otherwise normal healthy patients ≥6 mo with mild symptoms and/or uncertain diagnosis, consider no antibiotics and repeat evaluation in 2–3 days. 

Additional Reading

  • American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics.  2004;113:1451–1465.

  • Coker  TR, Chan...



  • 381.4 Nonsuppurative otitis media, not specified as acute or chronic

  • 381.60 Obstruction of Eustachian tube, unspecified

  • 382.9 Unspecified otitis media


  • H65.90 Unspecified nonsuppurative oti...

Subscribe to Access Full Content

Sign Up for a 10-Day Free Trial

Sign up for a 10-day FREE Trial now and receive full access to all content.