🦠 Acute Otitis Media (AOM)
• Most common <3y; >80% by age 3
• Middle ear inflammation + effusion + acute illness
• Major pathogens: NTHi, S. pneumoniae, M. catarrhalis
• Key DX: bulging, opaque, red TM with decreased mobility (pneumatic otoscopy)
🌊 Otitis Media with Effusion (OME)
• Fluid without infection/inflammation
• DO NOT treat with antibiotics
• Tympanometry helpful; watchful waiting
⚠️ Red flags & Surgical Mimics
• Mastoiditis: postauricular swelling, pinna displaced outward
• Cholesteatoma: white debris, retraction pocket → bone erosion
• Furuncle: severe pain with otoscope insertion
• Perichondritis/hematoma: cauliflower ear
💧 Otitis Externa (Swimmer's Ear)
• Risk: water exposure, cotton swabs, hearing aids
• Pathogens: Pseudomonas, S. aureus
• Edema, erythema, discharge, pain with tragus manipulation
📌 Decision strategy: Confirm AOM with bulging TM + acute symptoms. Avoid overdiagnosis. Antibiotic stewardship is critical. OME → observation. Persistent effusion with hearing loss → ENT referral.