Synopsis
Diagnose acute middle-ear inflammation, provide effective pain relief and choose observation or antibiotics while detecting children and adults who require urgent hospital assessment.
- Acute otitis media is an acute inflammatory illness of the middle ear, usually associated with fluid behind the eardrum.
- A bulging inflamed tympanic membrane supports the diagnosis more strongly than redness alone.
- Most children improve within about three days, although symptoms can continue for a week.
Key red flags
A child who is drowsy, poorly perfused, dehydrated or difficult to rouse needs urgent assessment of systemic illness irrespective of the ear findings.
Investigation priorities
Confirm the likely site and severity of uncomplicated illness.
Management branches
Uncomplicated disease has no immediate-treatment or hospital referral features.
- Give regular age- and weight-appropriate paracetamol or ibuprofen and explain how the family should administer it.
- Discuss no antibiotic or a back-up prescription according to the examination, symptom course and family circumstances.
Key medicines
Amoxicillin when an antibiotic is indicatedThe NHS Lothian adult AOM pathway uses 500 mg orally every eight hours for five days. NICE NG91 under-18 dosing is 125 mg three times daily at 1–11 months, 250 mg three times daily at 1–4 years, and 500 mg three times daily at 5–17 years, for five to seven days.
Phenazone 40 mg/g with lidocaine 10 mg/g ear dropsOtigo: instil four drops into the affected ear two or three times daily for up to seven days. The product dose applies to adults and children; review sooner if deterioration occurs and stop if discharge develops.