Acute otitis media (AOM) is a sudden-onset infection of the middle ear, the air-filled space behind the eardrum that contains the tiny vibrating bones responsible for hearing. It is one of the most common ENT conditions, particularly in infants and young children, though adolescents and adults can also be affected. AOM typically develops rapidly and is characterized by ear pain, fever, irritability, and hearing difficulties, making prompt diagnosis and management essential to prevent complications.

The condition usually begins with an upper respiratory tract infection such as a cold or flu. These infections cause inflammation and congestion of the Eustachian tube, which connects the middle ear to the back of the nose and throat. When this tube becomes blocked, fluid accumulates in the middle ear, creating an ideal environment for bacteria or viruses to multiply. Common bacterial organisms include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, while viral causes are also frequently implicated.

Symptoms of acute otitis media vary by age. In young children, signs may include persistent crying, pulling or tugging at the ear, difficulty sleeping, reduced appetite, and fever. Older children and adults often report sharp or throbbing ear pain, a feeling of pressure or fullness in the ear, temporary hearing loss, headache, and occasionally ear discharge if the eardrum ruptures. Hearing impairment during an acute episode is usually conductive and temporary but can significantly affect speech development in children if infections recur.

Diagnosis is primarily clinical and performed through otoscopic examination. The eardrum often appears red, bulging, and immobile due to fluid buildup behind it. Pneumatic otoscopy and tympanometry may be used to assess middle ear fluid more accurately. In recurrent or severe cases, additional investigations may be required to rule out complications or underlying anatomical issues.

Treatment of acute otitis media depends on the patient’s age, symptom severity, and overall health. Mild cases, especially in older children and adults, may be managed with a period of observation combined with pain control using analgesics such as paracetamol or ibuprofen. When bacterial infection is suspected or symptoms are severe, antibiotics are prescribed to eradicate the infection and prevent complications. Completing the full course of medication is critical to reduce recurrence and antibiotic resistance.

If left untreated or inadequately managed, acute otitis media can lead to complications such as tympanic membrane perforation, mastoiditis, facial nerve palsy, or progression to chronic otitis media. Recurrent episodes may also result in persistent middle ear effusion and long-term hearing problems.

Preventive strategies include timely treatment of upper respiratory infections, breastfeeding in infancy, avoiding exposure to tobacco smoke, and ensuring vaccinations are up to date. Early ENT evaluation is especially important for children with recurrent ear infections, speech delay, or hearing concerns. With appropriate medical care, most cases of acute otitis media resolve completely without lasting effects.