Snapshot A 9-month-old boy presents to your urgent care clinic for increased irritability. One week prior to presentation, the patient had an upper respiratory infection, which has since improved. Over the last day, the mother has noticed that the child has been tugging at his right ear, refuses to lie down on it, and has had a fever. There is right tympanic membrane erythema that is bulging and minimally mobile with pneumatic otoscopy. Introduction Definition middle ear infection Epidemiology Incidence peak of acute otitis media infection is between 6-18 months of age Risk factors immunocompromise viral upper respiratory tract infection family history Etiology Infectious Streptococcus pneumoniae (most common of the 3) nontypeable Haemophilus influenzae Moraxella (Branhamella) catarrhalis Viral respiratory syncytial virus rhinovirus adenovirus coronavirus influenza parainfluenza Pathoanatomy Pathogenesis typically, a viral upper respiratory tract infection leads to inflammatory changes to the respiratory mucosa of this aerated system edema leads to obstruction at the isthmus of the eustachian tube, which poorly ventilates the middle ear, creating negative pressure login to view 1 more bullet Anatomy the middle ear is an aerated system, which includes the mastoid air cells, eustachian tube, and the nares login to view 1 more bullet Presentation Symptoms nonspecific findings login to view 4 more bullets otalgia (most common complaint) login to view 1 more bullet Physical exam bulging or fullness of the tympanic membrane (TM) erythema of the TM possible perforation with otorrhea possibe absence of light reflex Studies Pneumatic otoscopy tympanic membrane bulging (most specific finding) poor tympanic membrane mobility tympanic membrane color is typically white or pale yellow Differential Otitis media with effusion differentiating factors login to view 3 more bullets Treatment Medical observation for a 2-day period login to view 1 more bullet amoxicillin login to view 10 more bullets amoxicillin-clavulanate login to view 2 more bullets Complications Hearing loss Tympanic perforation Tympanosclerosis Cholesteatoma Mastoiditis Meningitis Epidural and brain abscess Cavernous sinus thrombosis