Ear, Nose and Throat - U.S.A.  (ENT USA)
Middle Ear Infections - Acute Otitis Media
Middle Ear Infections
Acute Otitis Media (AOM)


Acute Otitis MediaAcute Otitis Media: The most common cause of fever is an acute ear infection or acute otitis media.  This is an infection of the middle ear and mastoid cavity.  Mastoiditis as used by the lay public actually refers to "Coalescent Mastoiditis" is a severe infection where the infection in the mastoid cavity starts to directly involve bone.  Complications such as meningitis, brain abscess or spread into the soft tissues of the skull may occur. 


Acute otitis media
can be caused by a number of different bacteria.  The most common are:  Streptococcus Pneumonia, Heamophilus Influenzae (this is not the flu virus), Moraxella catarrhalis.   Less commonly, Mycoplasma Pneumoniae, Streptococcus Pyogenes, Staphylococcus Aureus along with other bacteria and viruses.  Antibiotic resistance is not commonly seen in S. Pyrogenesis, S. Pneumonia and H. Influenza.  The resistance profile to S. Pneumonia can be extensive with few oral antibiotics being effective.  Because of bacterial resistance, prophylactic antibiotics, are no longer used to prevent ear infections.  Although effective in preventing ear infections, these low dose antibiotics promote and worsen bacterial resistance.

Pus Draining From an Ear TubeAcute otitis media in a patient with a myringotomy is often caused by Pseudomonas aeruginosa.   Heslop et. al reported that topical ciprofloxacin had a 23% failure rate which was lower than that found in patients treated with oral amoxicillin or with saline rinses.   View Abstract 

Acute Otitis Media With Blistering of the Eardrum(The bacterial resistance in S. Pneumonia is transmitted on a plasmid between the bacteria.  A single plasmid can carry the genes for resistance to both the penicillin and macrolide antibiotics.   This organism's resistance to penicillin is by producing a penicillin binding protein and not by producing penicillinase (an enzyme which breaks down penicillin.  Thus, this organism will also be resistant to Amoxcillin/Clavulanate and Amoxcillin/Sulbactam.  The mechanism of penicillin resistance in H. Influenzae is by the production of a B-lactamase which breaks down penicillin.  In this case, Amoxcillin/Clavulanate would be expected to be an effective antibiotic since Clavulanate neutralized the B-lactamase enzyme.)

Treatment is with oral antibiotics.  In cases of bacterial resistance, intravenous antibiotics may be necessary.  Antibiotic drops will not enter the
middle ear and are not used in acute otitis media unless the eardrum has ruptured and pus is draining out the ear canal. 

Acute otitis media: management and surveillance in an era of pneumococcal resistance--a report from the Drug-resistant Streptococcus pneumoniae Therapeutic Working Group.

Controversies in the Medical Management of Persistent and Recurrent Acute Otitis Media:  Recommendations of a Clinical Advisory Committee.

Patient Suggestion For Adults with a Middle Ear Infection (Otitis Media):  Ask your doctor if a generic medication may be able to treat your condition at a lower cost.  For example:

A discount pharmacy was consulted on Nov 20, 2007 (prices used in this example may change and vary).
1)  A 10 day supply of Augmentin XR taken two tablets twice a day for 10 days cost $139.94.   A similar dosage can be obtained by taking generic Augmentin 875 mg  every twelve hours alternating with Amoxicillin 1000 mg every twelve hours.  These dosages are alternated every size hours.  Thus, a total of four doses of antibiotics are taken each day.  Augmentin 875, Amoxicillin, Augmentin 875 and Amoxicillin.  The total cost of this medication regiment is $66.98 a savings of $72.96.

Vaccines:  H.Flue vaccine has dramatically reduced the incidence of infection to H. Influenza Type B.  A new vaccine Prevnar is a heptavalent Pneumococcal Vaccine to Streptococcus Pneumonia.  S. Pneumonia is a common cause of otitis media.  Unfortunately, many children who have recurrent otitis media may have already been exposed to many of the various types of S. Pneumonia which Prevnar vaccinates for.  Often the main problem in children with chronic otitis media, is not that they do not have antibodies to the bacteria but that they have eustachian tube dysfunction.  The effectiveness of Prevnar in children who already have recurrent otitis media needs more study.
Overall, in one study it was shown that Prevnar reduced the rate of office visits for otitis media by 7% and the placement of myringotomy tubes by 20%.     

Recommended Vaccination Schedules             Read More About Prevnar                Go To Prevnar's Home Page

Complications of Acute Otitis Media

Left untreated 50% of all cases of
acute otitis media will clear without antibiotics, but 1 in 400 may progress to acute coalescent mastoiditis, a life threatening ear infection; and rarely meningitis, a life threatening brain infection, can occur.   The infection can also spread from the ear, usually behind the ear where cellulitis or abscess may develop. 


Ways to help prevent Ear Infectionss

  • No pacifiers after 1 year of age

  • No smoking

  • Supine sleeping position

  • No bottle propping

  • Do not give a bottle in bed

  • No day care

  • Breast feed

Articles on Bacterial Resistance

Acute Otitis Externa This is an acute bacterial infection usually caused by Pseudomonas aeruginosa.  The outer ear canal is swollen shut, and the auricle is very painful to touch.  Treatment is to open the ear canal, place a wick, and treat with ear drops.  The wick is made of cloth or foam rubber which will allow the ear drops to penetrate the swollen canal.  Unfortunately, most oral antibiotics are ineffective.  Oral fluoroquinolones can be effective, but they are not approved in children. 



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Page Last Updated 08/24/2023 
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Other ENTUSA Links Regarding Ear Infections:

View S. Pneumonia Sensitivity Report on a 1 year old 


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