Check age

• AOM is mostly a condition seen in children; more than 75 per cent of episodes occur in children under 10 years of age
• Young children are more susceptible as they have shorter and more horizontal Eustachian tubes. As they grow, the condition is less likely to occur
• At least 70 per cent of children will experience one or more attacks of acute otitis media by the age of two years. Around a third of these have several episodes
• The peak age of incidence is six to 15 months and decreases with age. It is less common at school age. In the England Pharmacy First service, children aged from one year to 17 years may be assessed and treated
• AOM occurs less frequently in older people and is unusual in those over 18 years of age. Adults may report dizziness or unsteadiness.

For the Pharmacy First scheme, individuals under one year or over 18 years with suspected AOM and significant pain should be referred to their GP practice. This also applies to females who are pregnant (or with suspected pregnancy) under 16 years of age.

Association with viral respiratory infection

• Most people with suspected AOM will have a cold or flu-like illness. There is usually cough or nasal discharge (rhinorrhoea)
• Otitis media occurs more in the winter when respiratory viruses are more prevalent.

Acute onset of symptoms

• Older children and adults will describe sudden onset of earache, usually in one ear
• Adults will be more aware of hearing loss, associated with ear pain (otalgia)
• In younger children there may be signs of pain with holding, tugging or rubbing of the ear
• Young children may also have non-specific symptoms such as fever, crying, poor feeding, restlessness, behavioural changes and malaise. Vomiting may be a feature=
• Bilateral otitis media (both ears) is more common in those aged under two years
• Perforation of the eardrum often relieves pain. A child who is screaming and distressed may settle quickly when the ear starts to discharge pus.

Recurrent AOM

• Recurrence of AOM is common, particularly in children under two years of age. The Pharmacy First clinical pathway for AOM advises that a patient with three or more episodes in six months, or four or more episodes in 12 months, should be referred.