Acute suppurative otitis media

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Acute suppurative otitis media (ASOM) is inflammation of the middle ear cleft due to bacterial infection. It is also referred to as 'acute otitis media' or simply 'otitis media', although the correct definition of otitis media includes acute and non-infective causes.



ASOM is most common in children between the ages of 3 to 7 years. Such infants have a short, wide, more horizonally placed eustachian tube than adults, allowing contamination from the regurgitation of feed. Poor sanitation, over-crowding and malnutrition are all risk factors in children. Risk factors in all age groups include recurrent or chronic rhinosinusitis, chest disease and eustachian tube dysfunction. Causes of eustachian tube dysfunction include hypertrophy of the adenoids, cleft palate and submucous cleft palate.


ASOM is a bacterial disease caused by pus forming organisms. Pathogenic bacteria have been isolated from the nasopharynx in up to 97% of children with ASOM. The bacterial infection may be a primary infection, or secondary following a viral acute non-suppurative otitis media. Bacteria enter the middle ear cleft via the eustachian tube, a tympanic membrane perforation or are blood-borne. Common organisms include:

Clinical features

  • Deafness - a conductive hearing loss which progresses
  • Pain - due to accumulation of pus and pressure necrosis of the tympanic membrane
  • Otorrhoea - occurs after episodes of pain, and is due to perforation of the tympanic membrane and release of pus
  • Pyrexia - children are typically fretful with a high (>39 degrees c) pyrexia
  • Tympanic membrane - is initially dull, then becomes hyperaemic. Evenually becomes full, angry and red, and finally perforates if unresolved


  • Rest in a warm and well humidified room.
  • Antibiotics may be given. Some would give prophylactically to prevent the risk of perforation. Others would given only in the presence of uncontrolled pyrexia. Amoxicillin will cover most pathogenic organisms. However, up to 14% of cases have beta-lactamase resistance, and co-amoxiclav is recommended. There is some evidence that antibiotic use may increase the risk of recurrence.[1]
  • Decongestants have a traditional role to play, although they have not been proven to be of significant value.
  • Predisposing conditions to ASOM should be treated after resolution.



Perceptibly reduced by HiB immunisation of children

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