Acute otitis media (AOM) is an infection of the middle ear space, the air-filled cavity behind the eardrum that contains the tiny bones responsible for hearing. This condition develops when bacteria or viruses cause inflammation and fluid accumulation in the middle ear, resulting in pressure against the eardrum. Unlike otitis media with effusion (fluid without infection), acute otitis media involves active infection with symptoms including ear pain, fever, and temporary hearing difficulties. This condition is commonly seen in paediatric patients and represents a reason for medical consultations.
Acute Otitis Media Treatment in Singapore
Acute otitis media, commonly known as a middle ear infection, can cause significant pain and discomfort, particularly in young children. This condition occurs when the middle ear becomes inflamed and infected, often following a cold or upper respiratory infection. In Singapore’s tropical climate, where air conditioning is widely used and respiratory infections spread easily in densely populated areas, acute otitis media is a concern for both children and adults. Our ENT Specialists provide evaluation and treatment options for acute otitis media, which may help patients find relief from symptoms and support the prevention of potential complications.
Individual results and treatment outcomes may vary.
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
What is Acute Otitis Media?
Types of Acute Otitis Media
Uncomplicated Acute Otitis Media
This is a common form, characterised by middle ear infection without spreading beyond the ear cavity. Symptoms may include ear pain, fever, and mild hearing loss. The infection remains confined to the middle ear space and can respond to appropriate treatment. Cases in otherwise healthy individuals often fall into this category.
Recurrent Acute Otitis Media
Defined as multiple episodes within a specified timeframe with complete resolution between infections. Children attending childcare centres may be susceptible due to increased exposure to respiratory pathogens. This pattern often indicates underlying factors requiring evaluation.
Severe Acute Otitis Media
This type presents with intense symptoms, including severe ear pain, high fever, and marked irritability. The eardrum may show significant bulging and inflammation. Some cases may progress to tympanic membrane perforation (ruptured eardrum) with discharge. Severe acute otitis media requires prompt medical attention to prevent complications.
Causes & Risk Factors
Causes
The primary causes of acute otitis media involve pathogen invasion of the middle ear space. Bacterial infections may account for cases, with Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis being common pathogens. Viral infections, including respiratory syncytial virus (RSV), influenza, and rhinovirus, can cause the condition or create conditions that may favour secondary bacterial infection.
Eustachian tube dysfunction plays a role in development. The eustachian tube connects the middle ear to the back of the throat, normally draining fluids and equalising pressure. When this tube becomes blocked due to inflammation, allergies, or anatomical factors, fluid may accumulate in the middle ear, creating an environment that could be conducive to bacterial growth.
Risk Factors
- Age: Children between 6 months and 2 years may face a higher risk due to developing immune systems and horizontal eustachian tubes
- Childcare attendance: Group settings may increase exposure to respiratory infections
- Seasonal factors: Higher incidence may occur during rainy seasons when people spend more time indoors
- Passive smoking: Exposure to cigarette smoke may irritate the eustachian tube and respiratory tract
- Bottle feeding while lying down: Can cause milk to enter the eustachian tube
- Allergies: Chronic nasal congestion may affect eustachian tube function
- Family history: Genetic predisposition to ear infections
- Cleft palate or Down syndrome: Anatomical differences affecting eustachian tube function
- Recent upper respiratory infection: Creates inflammation that may facilitate bacterial migration
Signs & Symptoms
Early Symptoms
- Mild ear discomfort or fullness sensation
- Slight hearing reduction or muffled sounds
- Low-grade fever
- Increased irritability in children
- Tugging or pulling at the affected ear
Peak Symptoms
- Severe ear pain, often worse when lying down
- High fever
- Significant hearing loss in the affected ear
- Drainage from the ear if the eardrum ruptures
- Dizziness or balance problems
- Nausea or vomiting
- Difficulty sleeping due to pain
- Loss of appetite
Resolution Phase
- Gradual pain reduction
- Fever subsiding
- Improved hearing as fluid drains
- Return of normal appetite and activity
- Possible persistent fluid sensation
Symptoms may develop rapidly, often following an upper respiratory infection. The severity and duration can vary depending on the causative organism and individual immune response. Young children may be unable to verbalise ear pain, instead showing behavioural changes like increased crying or sleep disturbance.
Experiencing these symptoms?
Consult with an ENT specialist for an accurate diagnosis and appropriate treatment plan.
When to See a Doctor
Seek immediate medical attention if you or your child experiences severe ear pain lasting more than a day, ear discharge containing blood or pus, or a high fever above 39°C. Other concerning signs include facial weakness or asymmetry, severe headache, confusion, or swelling behind the ear, which may indicate mastoiditis. Persistent symptoms despite antibiotic treatment also warrant reassessment.
For children under six months, any suspected ear infection requires prompt evaluation due to their developing immune systems and inability to communicate symptoms. Adults with recurrent infections, diabetes, or compromised immune systems should seek early treatment to prevent complications.
During your consultation, the ENT specialist may examine the ear using an otoscope to visualise the eardrum’s appearance, checking for redness, bulging, or perforation. They may also assess hearing function and examine the nose and throat for related infections. The examination is generally quick and minimally uncomfortable, though young children may require gentle restraint for accurate visualisation.
Diagnosis & Testing Methods
Otoscopic Examination
The diagnostic tool involves direct visualisation of the tympanic membrane (eardrum) using an otoscope. The ENT specialist looks for signs, including eardrum bulging, redness, loss of normal landmarks, and reduced or absent light reflex. In acute otitis media, the eardrum typically appears opaque and inflamed rather than its normal pearlescent appearance.
Pneumatic Otoscopy
This examination technique tests eardrum mobility by introducing gentle air pressure through the otoscope. Normal eardrums move freely with pressure changes, while infected ears show reduced or absent movement due to fluid behind the eardrum. This test helps differentiate acute otitis media from other ear conditions and provides information about middle ear status.
Tympanometry
This test measures middle ear pressure and eardrum compliance using sound waves and air pressure. A small probe placed in the ear canal generates results. Tympanometry produces a graph showing middle ear function, helping confirm fluid presence and eustachian tube dysfunction. The test is painless and may be useful for young children who cannot describe symptoms.
Hearing Assessment
Audiometry may be performed if hearing loss persists or recurrent infections occur. Age-appropriate testing methods range from behavioural observation and audiometry for infants to standard pure-tone audiometry for older children and adults. These tests establish baseline hearing levels and monitor for infection-related hearing changes.
Treatment Options Overview
Observation and Supportive Care
For patients with mild symptoms, watchful waiting may be appropriate. This involves symptom management whilst monitoring for improvement or deterioration over 48-72 hours. Pain relief using paracetamol or ibuprofen at appropriate doses may provide comfort. Warm compresses applied to the affected ear may offer additional relief. This approach can be considered for older children and adults with mild symptoms and no risk factors for complications.
Antibiotic Therapy
When indicated, oral antibiotics may be prescribed for bacterial acute otitis media. Amoxicillin can serve as first-line therapy due to its effectiveness against common pathogens. The course duration varies depending on age and severity. For patients allergic to penicillin or with recent antibiotic exposure, alternative antibiotics like azithromycin or cefuroxime may be prescribed. Treatment selection considers local resistance patterns and individual patient factors.
Antibiotic Ear Drops
Following spontaneous or surgical eardrum perforation, topical antibiotic drops may be prescribed. These medications aim to deliver antibiotic concentrations directly to the infection site whilst minimising systemic effects. Ofloxacin or ciprofloxacin drops may be used, often combined with corticosteroids, to help reduce inflammation. Proper administration technique helps ensure medication reaches the middle ear space effectively.
Pain Management Strategies
Adequate analgesia may improve comfort and aid recovery. Oral pain relievers, including paracetamol and ibuprofen, are dosed according to weight in children. Topical anaesthetic drops may provide temporary relief for intact eardrums, though they should not delay definitive treatment. Non-pharmacological methods like elevation of the affected ear and distraction techniques can complement medical pain management.
Myringotomy
This minor surgical procedure involves creating a small incision in the eardrum to drain infected fluid, which may provide pressure relief. Performed under local or brief general anaesthesia, myringotomy may be considered when pain persists despite medical treatment or complications threaten. The incision typically heals within days to weeks. Fluid samples may be collected for culture to guide antibiotic selection in resistant cases.
Tympanostomy Tube Insertion
For recurrent acute otitis media or persistent effusion, ventilation tube placement may be recommended. These tubes aim to maintain middle ear ventilation and help prevent fluid accumulation. The procedure takes approximately 15 minutes under general anaesthesia. Tubes usually remain in place for 6-18 months before natural extrusion. This intervention may help reduce infection frequency in appropriately selected patients.
Every patient’s condition is unique.
Our ENT Specialist can assess your specific situation and recommend the most suitable treatment approach for you.
Complications if Left Untreated
Untreated acute otitis media may lead to complications affecting hearing and overall health. Tympanic membrane perforation (eardrum rupture) can occur when pressure causes the eardrum to burst, resulting in drainage and potential chronic ear problems. Perforations may heal on their own or require surgical repair depending on their characteristics.
Mastoiditis is an infection spreading to the mastoid bone behind the ear and represents a potential complication. This condition can cause swelling, redness, and tenderness behind the ear, potentially forming abscesses that may require surgical drainage. Chronic suppurative otitis media may develop, characterised by persistent ear discharge and conductive hearing loss requiring long-term management.
Rare but severe intracranial complications include meningitis, brain abscess, and lateral sinus thrombosis. These conditions require immediate hospitalisation and treatment.
Even uncomplicated infections can cause temporary or permanent hearing loss, affecting speech development in young children and quality of life in adults. Academic performance and social development may be affected in children with recurrent infections and associated hearing difficulties.
Consult a healthcare professional for proper evaluation and management.
Prevention
Reducing acute otitis media risk involves multiple strategies addressing modifiable factors. Breastfeeding for at least six months provides antibodies and promotes favourable eustachian tube positioning during feeding. When bottle-feeding, holding infants upright prevents milk from entering the eustachian tubes. Avoiding pacifier use after six months may help reduce infection risk.
Maintaining good hand hygiene limits respiratory infection transmission, particularly in high-density living environments. Keeping children’s vaccinations current, including pneumococcal and influenza vaccines, may help reduce infection-causing pathogens. The pneumococcal vaccine can help decrease acute otitis media incidence caused by vaccine-covered strains.
Environmental modifications include eliminating exposure to cigarette smoke and managing allergies effectively to reduce eustachian tube inflammation. Limiting childcare group size when possible decreases pathogen exposure. For swimming enthusiasts, proper ear protection and thorough drying after water activities help prevent external ear infections that may progress to middle ear involvement.
For Singaporeans & Singapore Permanent Residents
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Your ENT procedure may be eligible for Medisave claims, with the claimable amount varying based on the procedure’s complexity. For additional options, including the use of your insurance or Integrated Shield Plan, reach out to our friendly clinic staff today for assistance.
Frequently Asked Questions (FAQ)
Can acute otitis media resolve without antibiotics?
Some cases of mild acute otitis media may resolve within a few days without antibiotics, particularly in children over two years with mild symptoms. The body’s immune system can often help clear the infection naturally. Your ENT specialist may determine whether watchful waiting or immediate antibiotic treatment is appropriate based on age, symptom severity, and examination findings. Close monitoring aims to ensure prompt intervention if symptoms worsen.
Is acute otitis media contagious?
Acute otitis media itself is not contagious, but the respiratory infections that often precede it are transmissible. The bacteria and viruses causing upper respiratory infections spread through respiratory droplets from coughing and sneezing. While you cannot catch an ear infection directly from someone, you may contract the cold or flu that leads to one. Practising good hygiene and avoiding close contact with sick individuals can help reduce transmission risk.
How long does recovery from acute otitis media take?
With appropriate treatment, acute symptoms like pain and fever may improve within a few days. Complete resolution of middle ear fluid may take several weeks to months, during which mild hearing reduction may persist. Patients may experience symptom relief when antibiotics are prescribed. Follow-up examination after treatment completion aims to ensure proper healing and identify any persistent fluid requiring additional management.
Can flying worsen acute otitis media?
Air travel during active infection is generally discouraged, as pressure changes during takeoff and landing can worsen pain and potentially cause eardrum perforation. The inability to equalise ear pressure due to eustachian tube dysfunction and inflammation makes flying particularly uncomfortable and risky. Wait until your ENT specialist confirms infection resolution before flying. If travel is unavoidable, discuss preventive measures and pain management strategies with your doctor.
Why do some children get recurrent ear infections?
Multiple factors contribute to recurrent infections, including immature immune systems, anatomical variations in eustachian tube angle and function, exposure to pathogens in childcare settings, and genetic predisposition. Underlying conditions like allergies, enlarged adenoids, or cleft palate may increase susceptibility. Identifying and addressing specific risk factors through comprehensive evaluation can help develop targeted prevention strategies and determine whether surgical intervention, like tube placement, would be beneficial.
What’s the difference between swimmer’s ear and acute otitis media?
Swimmer’s ear (otitis externa) affects the outer ear canal, while acute otitis media involves the middle ear space behind the eardrum. Otitis externa may cause pain when pulling the outer ear, visible canal inflammation, and sometimes discharge, often following water exposure. Acute otitis media can cause deep ear pain, fever, and hearing reduction with eardrum changes visible only through otoscopic examination. Treatment approaches differ, making an accurate diagnosis essential.
When should tympanostomy tubes be considered?
Tube placement may be recommended for children with recurrent ear infections or persistent middle ear fluid with hearing loss. Additional factors include antibiotic resistance, complications from previous infections, or developmental concerns related to hearing loss. Your ENT specialist can evaluate individual circumstances, weighing potential benefits against risks to determine optimal timing for this intervention.
Conclusion
Acute otitis media remains a common condition affecting both children and adults in Singapore. While the infection can cause discomfort and temporary hearing difficulties, recognition and appropriate treatment may help achieve positive outcomes in many cases. Understanding the signs, symptoms, and risk factors enables intervention, which may help prevent potential complications and reduce the likelihood of recurrence. With various treatment options available, from watchful waiting to surgical intervention, management can be tailored to each patient’s specific needs and circumstances. Modern diagnostic techniques and evidence-based treatments aim to provide effective care whilst minimising unnecessary antibiotic use.
Take the First Step Towards Better Ear Health
Living with acute otitis media can be uncomfortable and disruptive. Our ENT Specialist has experience diagnosing and treating acute otitis media using current evidence-based approaches.
This treatment is administered as part of a comprehensive plan supervised by a healthcare professional.
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
With over 15 years of experience, Dr Gan specialises in the comprehensive management of a broad range of conditions related to the ear, nose and throat (ENT), and head and neck.
Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.
- 2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
- 2016 – Best Educator Award (Eastern Health Alliance)
- 2016 – “Wow” Award (Patient Compliment)
- 2014 – Eastern Health Alliance Caring Award – Silver
- 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
- 2012 – Human Manpower Development Award (Ministry of Health, Singapore)
- 2007 – Singhealth Best Doctor Award
Qualifications
- MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
- MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
- MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
- FAMS – Fellow of the Academy of Medicine Singapore
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