Acute Otitis Media & Mastoid Complications
Recognise middle-ear infection, support appropriate prescribing and identify spreading disease.
Quick revision ↓ Medical Dictionary
01Diagnose clinically
Acute otitis media involves acute symptoms with middle-ear inflammation and effusion, often after an upper respiratory infection. A bulging tympanic membrane is more informative than redness alone, which can occur with crying or irritation. Assess pain, fever, hydration and general condition. Age and risk factors influence the examination and management plan.
02Relieve pain
Analgesia and supportive care are central to management. Many uncomplicated episodes improve without immediate antibiotics, but prescribing depends on severity, age, otorrhoea, bilateral disease in younger children and risk of complications. Use local age-appropriate guidance rather than a single treatment rule. Explain expected progress and how to obtain review if symptoms worsen or fail to improve.
03Discharge and perforation
New otorrhoea may follow tympanic membrane perforation, but canal infection remains a differential. Avoid unsafe drops or irrigation when perforation is possible. Persistent discharge or hearing difficulty needs follow-up to confirm resolution and assess the drum. A decrease in pain after discharge begins does not prove that all complications have been excluded.
04Mastoid warning signs
Postauricular tenderness, swelling or erythema with displacement of the pinna raises concern for mastoiditis. Fever and ongoing ear symptoms support urgency. Arrange urgent hospital ENT assessment rather than waiting for routine follow-up. Imaging and treatment are selected by the specialist team, and associated neurological or systemic deterioration requires emergency escalation.
05Intracranial and neurological complications
Severe headache, meningism, altered consciousness, focal deficits or facial weakness in the context of ear infection are red flags. Assess physiological stability and obtain urgent specialist help. Routine outpatient treatment is insufficient when spread is suspected. Clear safety-net instructions help families distinguish ordinary discomfort from a child or adult becoming seriously unwell.
High-Yield Revision
- A red drum alone does not establish acute otitis media.
- Analgesia is important whether or not antibiotics are used.
- Postauricular swelling and neurological signs require urgent escalation.
Common Pitfalls
- Prescribing the same antibiotic plan for every age and severity.
- Ignoring persistent discharge after apparent pain relief.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.