Acute Otitis Media vs Otitis Externa
Acute Otitis Media and Otitis Externa are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Acute Otitis Media vs Otitis Externa at a glance
- Acute Otitis Media: Acute middle ear infection with effusion and signs of inflammation, most common in young children.
- Otitis Externa: Acute inflammation of the external auditory canal, usually bacterial, often associated with water exposure.
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Side-by-side comparison
| Feature | Acute Otitis Media | Otitis Externa |
|---|---|---|
| At a glance | Acute middle ear infection with effusion and signs of inflammation, most common in young children. | Acute inflammation of the external auditory canal, usually bacterial, often associated with water exposure. |
| Classic presentation | Bulging, opacified TM with impaired mobility on pneumatic otoscopy in a febrile child with otalgia.; Ear pain (otalgia) — pulling/tugging at ear in preverbal children; Fever, irritability, poor feeding, disrupted sleep; Preceding URI symptoms (rhinorrhea, cough); Hearing loss; otorrhea if TM has perforated; In older children/adults:… | Pain with tragal/pinna manipulation plus erythematous, debris-filled canal.; Ear pain, often severe and out of proportion to visible findings; Pruritus (especially fungal); Sensation of fullness or hearing loss from canal swelling; Otorrhea — purulent, scant, or watery; Tenderness on tragal pressure or pinna traction — classic… |
| Workup / key labs | AAP 2013: (1) Moderate-to-severe bulging of TM or new-onset otorrhea not due to otitis externa, OR (2) mild bulging with recent (<48 h) onset of ear pain or intense erythema of TM. Middle ear effusion must be present.; AOM is a clinical diagnosis; laboratory testing is rarely needed; Tympanocentesis with culture reserved for treatment… | AAO-HNS 2014: rapid onset (≤48 h) within last 3 weeks PLUS symptoms of ear canal inflammation (otalgia, itching, fullness) PLUS signs of canal inflammation (tenderness of tragus/pinna OR diffuse canal edema/erythema).; Clinical diagnosis; cultures rarely needed in uncomplicated AOE; Culture if treatment failure, recurrent,… |
| Imaging | Pneumatic otoscopy or tympanometry — confirms middle ear effusion when otoscopy ambiguous; CT temporal bone if mastoiditis, intracranial complication, or cholesteatoma suspected | Not routinely needed for uncomplicated AOE; CT temporal bone with contrast or technetium-99m bone scan if malignant OE suspected (bony erosion, skull base osteomyelitis); MRI with gadolinium to evaluate intracranial extension |
| First-line treatment | Amoxicillin 80-90 mg/kg/day divided BID × 10 days (5-7 days if age ≥6 y and non-severe) — preferred if no amoxicillin in prior 30 days, no concurrent purulent conjunctivitis, and no history of recurrent AOM unresponsive to amoxicillin; Amoxicillin-clavulanate 90 mg/kg/day amoxicillin component if any of the above risk factors are… | Topical otic antibiotic — ofloxacin 0.3%, ciprofloxacin/dexamethasone, or neomycin/polymyxin B/hydrocortisone × 7-10 days; Use fluoroquinolone-containing drops (ofloxacin or ciprofloxacin) if TM perforation or tympanostomy tubes present — neomycin and aminoglycosides are ototoxic; Aural toilet (gentle suction/curettage under direct… |
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