Diagnostic Definitions

Acute Otitis Media (AOM)

Middle Ear Effusion (MEE) - demonstrated by pneumatic otoscopy, tympanometry,

air fluid level, or a bulging tympanic membrane plus
Evidence of acute inflammation opaque, white, yellow, or erythematous tympanic
membrane or purulent effusion plus
Symptoms of otalgia, irritability, or fever

Otitis Media with Effusion (OME) MEE without symptoms of AOM with or without
evidence of inflammation

Distinguishing AOM and OME. The distinction between AOM and OME does not refer
to etiology or depend on whether pathogenic bacteria are present in the middle ear. No
gold standard exists for the diagnosis of AOM. The National AOM-guideline defines
AOM as a combination of :

1) middle ear effusion,

2) physical evidence of middle ear inflammation, and
3) the acute (< 48 hours) onset of signs and symptoms (i.e. ear pain, irritability, fever)
referable to the middle ear.

Otitis media with effusion (OME) is defined as middle ear effusion (MEE) in the absence
of acute symptoms.

Part I: Acute Otitis Media, Management of AOM

For most children, antibiotics are not warranted. Spontaneous resolution of AOM is to be
expected in approximately 80 per cent of children.
AOM does not always require antibiotics, providing that good follow up is
provided.
Aggressively manage pain with adequate systemic analgesics (not ASA).
If a child is significantly unwell after 48-72 hours of analgesics, treat with
antibiotics regardless of age.
Decongestants, antihistamines and steroids are not beneficial in the treatment of
AOM.

Part II: Otitis Media with Effusion (OME)

OME is associated with ear discomfort and recurrences of acute otitis media (AOM) and
often follows an episode of AOM. Transient hearing loss is frequently associated with
OME. Spontaneous resolution of OME occurs in 90 per cent of patients within three
months of infection.
On Going Care
When OME has been present for at least 12 weeks, observation is advised at 3 month
intervals until the resolution of effusion. If there are concerns of significant hearing loss
or structural abnormalities of the tympanic membrane, a formal hearing evaluation and
referral to an otolaryngologist is recommended.
Note: Decongestants, antihistamines, steroids, and antibiotics are NOT recommended in
the treatment of OME.