Acute Otitis Media: Symptoms, Antibiotics, and Treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Acute otitis media is the most common pediatric bacterial infection. Otoscopic diagnosis, antibiotic therapy criteria, amoxicillin, and surveillance in Quebec.\">\n<meta name=\"keywords\" content=\"otite moyenne aigu\u00eb, OMA, otite moyenne aigu\u00eb enfant, otite moyenne aigu\u00eb traitement, amoxicilline otite, otite moyenne aigu\u00eb antibiotiques, otite moyenne aigu\u00eb diagnostic, otoscopie OMA, otite r\u00e9cidivante, otite moyenne aigu\u00eb Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n@import url('https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap');\n\n.co-wrap * {\n font-family: 'Poppins', sans-serif;\n box-sizing: border-box;\n}\n.co-wrap {\n max-width: 1100px;\n margin: 0 auto;\n padding: 30px 0 60px;\n margin-top: 10px;\n}\n.co-label {\n font-family: 'Cinzel', serif;\n font-size: 14px;\n font-weight: bold;\n letter-spacing: 1px;\n text-transform: uppercase;\n color: #4D6577;\n margin-bottom: 14px;\n display: block;\n}\n.co-wrap h1 {\n font-size: 32px;\n font-weight: 500;\n color: #323C52;\n margin: 0 0 22px;\n line-height: 1.2;\n letter-spacing: 0.5px;\n}\n.co-intro {\n font-size: 16px;\n font-weight: 400;\n line-height: 1.75;\n color: #4D6577;\n margin-bottom: 36px;\n padding-bottom: 32px;\n border-bottom: 1px solid rgba(77,101,119,.2);\n}\n.co-wrap h2 {\n font-size: 20px;\n font-weight: 600;\n color: #323C52;\n margin: 32px 0 12px;\n letter-spacing: 0.3px;\n}\n.co-wrap p {\n font-size: 15px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.7;\n margin-bottom: 14px;\n}\n.co-list {\n list-style: none;\n padding: 0;\n margin: 12px 0 24px;\n}\n.co-list li {\n font-size: 15px;\n font-weight: 400;\n color: #4D6577;\n padding: 10px 14px 10px 38px;\n margin-bottom: 8px;\n border-radius: 6px;\n position: relative;\n background: rgba(77,101,119,.06);\n border-left: 3px solid #4D6577;\n}\n.co-list li::before {\n content: \"\u2713\";\n position: absolute;\n left: 12px;\n font-weight: 700;\n color: #4D6577;\n}\n.co-table {\n width: 100%;\n border-collapse: collapse;\n margin: 14px 0 22px;\n font-size: 14px;\n border-radius: 8px;\n overflow: hidden;\n}\n.co-table thead tr {\n background: #323C52;\n color: #fff;\n}\n.co-table thead th {\n padding: 11px 16px;\n text-align: left;\n font-weight: 600;\n font-size: 13px;\n}\n.co-table tbody tr:nth-child(even) {\n background: rgba(77,101,119,.06);\n}\n.co-table tbody tr:nth-child(odd) {\n background: #fff;\n}\n.co-table td {\n padding: 10px 16px;\n color: #4D6577;\n border-bottom: 1px solid rgba(77,101,119,.12);\n font-size: 14px;\n vertical-align: top;\n}\n.co-table td:first-child {\n font-weight: 600;\n color: #323C52;\n}\n.co-infobox {\n display: flex;\n gap: 12px;\n background: rgba(77,101,119,.06);\n border-radius: 8px;\n border-left: 4px solid #4D6577;\n padding: 14px 18px;\n margin: 18px 0 28px;\n font-size: 14px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.65;\n}\n.co-infobox .ico {\n font-size: 18px;\n flex-shrink: 0;\n}\n.co-urgence {\n background: #fff8f8;\n border-left: 5px solid #c0392b;\n border-radius: 6px;\n padding: 20px 26px;\n margin: 24px 0 32px;\n}\n.co-urgence .co-urgence-titre {\n font-size: 13px;\n font-weight: 700;\n color: #c0392b;\n letter-spacing: 1.5px;\n text-transform: uppercase;\n margin-bottom: 10px;\n}\n.co-urgence p {\n color: #5a2020;\n font-size: 14px;\n margin: 0 0 10px;\n line-height: 1.7;\n}\n.co-urgence p:last-child {\n margin-bottom: 0;\n}\n.co-disclaimer {\n font-size: 13px;\n color: #8a9aaa;\n font-style: italic;\n border-top: 1px solid rgba(77,101,119,.15);\n padding-top: 24px;\n margin-top: 40px;\n line-height: 1.6;\n}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n\n <span class=\"co-label\">Pediatrics & Otolaryngology & Family Medicine<\/span>\n <h1>Acute otitis media (AOM)<\/h1>\n\n <div class=\"co-intro\">\n Acute otitis media (AOM) is an acute infection of the middle ear - the enclosed cavity bounded by the eardrum at the front, the mastoid at the back and the Eustachian tube at the bottom - constituting the most frequent bacterial infection in children and the leading cause of antibiotic prescriptions in pediatrics in industrialized countries. It affects around 80 % of children under the age of 3, with peak incidence between 6 and 24 months, coinciding with the period of daycare attendance, incomplete immunological maturation and maximum tubal vulnerability. The pathophysiology is a virtually constant progression from a viral infection of the upper respiratory tract (rhinovirus, respiratory syncytial virus, influenza), which causes inflammation and dysfunction of the Eustachian tube - the canal that ensures ventilation and drainage of the middle ear - to bacterial superinfection of the obstructed airspace of the tympanic case, with bacteria colonizing the nasopharynx, taking advantage of the tubal obstruction to ascend into the middle ear. The three main bacterial agents are <em>Streptococcus pneumoniae<\/em> (30 to 40 % of cases), <em>Haemophilus influenzae<\/em> non-typable (30 to 40 %) and <em>Moraxella catarrhalis<\/em> (10 to 15 %). The diagnosis is clinical and otoscopic\u2014diagnosis confirmation relies on direct visualization of a bulging, hyperemic, and opaque tympanic membrane, with loss of the light reflex. The main therapeutic challenge is to define whether antibiotic therapy is necessary\u2014spontaneous resolution occurring in 80 to 90 %of children over 2 years of age with non-severe AOM\u2014or if close monitoring without antibiotics is appropriate, as part of a strategy to preserve antibiotic resistance.\n <\/div>\n\n <h2>Pathophysiology and risk factors<\/h2>\n <ul class=\"co-list\">\n <li><strong>Central role of the Eustachian tube:<\/strong> Upper airway viral infection -> inflammation of the nasopharyngeal mucosa -> edema and tubal obstruction -> negative pressure in the tympanic cavity -> aspiration of nasopharyngeal secretions containing pathogenic bacteria -> bacterial multiplication in a closed, unventilated environment -> suppuration -> bulging, hyperemic, and painful eardrum<\/li>\n <li><strong>Child Anatomical Vulnerability<\/strong> Eustachian tube is shorter, more horizontal, less rigid, and opens less effectively during swallowing than in adults, explaining the peak prevalence between 6 months and 3 years. As the child grows and the tube lengthens and becomes more oblique, the frequency of OMAs (otitis media acute) spontaneously decreases.<\/li>\n <li><strong>Primary risk factors:<\/strong> Attending daycare (risk x 2-3 - increased exposure to viruses and bacteria) + bottle feeding in a reclined position (milk reflux into the eustachian tube) + passive smoking (impairment of tubal mucociliary transport) + formula feeding vs. breastfeeding (breast milk protects via secretory IgA and macrophages) + family history of recurrent AOM + cleft palate (congenital tubal dysfunction) + immunosuppression<\/li>\n <\/ul>\n\n <h2>Diagnostics \u2014 Clinical and Otoscopic Criteria<\/h2>\n <ul class=\"co-list\">\n <li><strong>Functional signs<\/strong> Acute unilateral ear pain (young child who cannot verbalize pain pulls at ear + cries + is irritable + sleeps poorly + refuses to feed or eat due to worsening pain with swallowing) + fever (present in 50 to 75 % of cases \u2014 but otitis media can exist without fever) + temporary hearing loss + sometimes purulent otorrhea if spontaneous tympanic membrane perforation (paradoxically favorable sign \u2014 pain is often relieved) + absence of tragus pain (unlike external otitis)<\/li>\n <li><strong>Otoscopy \u2014 positive diagnostic criteria:<\/strong> Bulging eardrum (convex towards the canal) + or opaque + hyperemic + with loss of the light reflex and normal landmarks + or purulent effusion visible behind the eardrum \u2192 simultaneous presence of effusion AND acute inflammation of the eardrum = certain acute otitis media + pneumatic otoscopy (eardrum mobility test under pressure) improves diagnostic accuracy (reduced mobility = effusion) + tympanometry (flat curve = type B) confirms effusion<\/li>\n <li><strong>OMA certain vs probable vs otitis media with effusion<\/strong> ACUTE OTITIS MEDIA (AOM) certain: bulging + hyperemic + opaque tympanic membrane + fever + ear pain + PROBABLE AOM: slightly pink or opaque tympanic membrane + mild changes without frank bulging + OTITIS MEDIA WITH EFFUSION (OME): non-inflamed tympanic membrane + effusion without acute signs + no fever or ear pain \u2192 do not treat with antibiotics<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span>The distinction between acute otitis media (AOM) and otitis media with effusion (OME\u2014effusion without acute inflammation) is fundamental because their treatments differ radically: AOM may warrant antibiotics depending on age and severity criteria, whereas OME should never be treated with antibiotics (no demonstrated benefit + increased resistance). The pneumatic otoscope is the most effective tool for this distinction\u2014to be used systematically in children with ear pain.<\/span>\n <\/div>\n\n <h2>Therapeutic decision \u2014 who to treat with antibiotics?<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Clinical situation<\/th>\n <th>Therapeutic recommendation<\/th>\n <th>Justification<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Infant < 6 months with certain or probable acute otitis media<\/td>\n <td>Systemic antibiotic therapy from the outset, without delay + hospitalization if general condition is altered or temperature is high<\/td>\n <td>High risk of serious complications (meningitis + mastoiditis) + immune immaturity + less frequent spontaneous resolution in this age group<\/td>\n <\/tr>\n <tr>\n <td>Child 6 months to 2 years with definite bilateral otitis media<\/td>\n <td>Empirical antibiotic therapy + amoxicillin 80\u201390 mg\/kg\/day in 2 doses \u00d7 10 days<\/td>\n <td>Bilateral OMA is associated with a higher risk of spontaneous resolution and complications + the 2013 AAP and 2016 SCP recommendations advocate for upfront antibiotic therapy.<\/td>\n <\/tr>\n <tr>\n <td>Child 6 months to 2 years with severe unilateral OMA (fever \u2265 39\u00b0C or severe otalgia)<\/td>\n <td>Empirical antibiotic therapy<\/td>\n <td>Clinical severity \u2192 antibiotic therapy without delay for pain control and prevention of complications<\/td>\n <\/tr>\n <tr>\n <td>Child 6 months to 2 years with unilateral, non-severe acute otitis media<\/td>\n <td>Option 1: immediate antibiotic therapy + Option 2: active observation (watchful waiting) for 48\u201372 hours with deferred antibiotic prescription + if worsening or no improvement \u2192 start antibiotics<\/td>\n <td>80% % spontaneous resolution in children over 6 months with unilateral non-severe AOM + reduced antibiotic consumption without increased complications in randomized trials<\/td>\n <\/tr>\n <tr>\n <td>Child \u2265 2 years old with non-severe acute otitis media (unilateral or bilateral)<\/td>\n <td>Active observation (watchful waiting) recommended first-line + analgesia + delayed prescription given to parents if worsening<\/td>\n <td>Spontaneous resolution in 80-90 % of cases + reduction of antibiotic side effects (diarrhea + candidiasis + allergy) + preservation of flora + reduction of antibiotic resistance<\/td>\n <\/tr>\n <tr>\n <td>OMA with purulent otorrhea (perforation)<\/td>\n <td>Empirical oral antibiotic therapy + local antibiotic ear drops (ciprofloxacin) if abundant discharge<\/td>\n <td>Tympanic perforation indicates active bacterial AOM, and otorrhea facilitates access of topical antibiotics to the middle ear.<\/td>\n <\/tr>\n <tr>\n <td>Recurrent OMA (\u2265 3 episodes in 6 months or \u2265 4 in 12 months)<\/td>\n <td>Focus on pediatric ENT for discussion of tympanostomy tubes (TT) + no long-term prophylactic antibiotics (not recommended)<\/td>\n <td>Antimicrobial Treatments reduce the number of recurrent OMA episodes by 50-60% % whereas prophylactic antibiotic therapy exposes to resistance without clear benefit.<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Antibiotic therapy \u2014 choice and dosage<\/h2>\n <ul class=\"co-list\">\n <li><strong>Amoxicillin \u2014 first choice:<\/strong> 80 to 90 mg\/kg\/day orally in 2 divided doses \u00d7 10 days (child < 2 years) or \u00d7 5 to 7 days (child \u2265 2 years with non-severe OMA) + optimal pneumococcal coverage including penicillin-non-susceptible *Streptococcus pneumoniae* (PNSP) strains thanks to high doses + advantages: narrow spectrum + well-tolerated + inexpensive + available as syrup<\/li>\n <li><strong>Amoxicillin-clavulanate (Clavulin\u00ae) \u2014 if failure at 48\u201372 hours or if recent antibiotic therapy (< 30 days):<\/strong> 90 mg\/kg\/day amoxicillin + 6.4 mg\/kg\/day clavulanate in 2 doses \u00d7 10 days + indicated for amoxicillin-resistant AOM (beta-lactamase-producing strains of'<em>H. influenzae<\/em> or <em>M. catarrhalis<\/em>) + more frequent digestive side effects (diarrhea)<\/li>\n <li><strong>Ceftriaxone IM 50 mg\/kg single dose (max 1 g) \u2014 if vomiting or true penicillin allergy:<\/strong> Very effective against pneumococcus + good option if the child cannot take orally + or if there is a documented penicillin allergy (check the type of allergy \u2014 penicillin-cephalosporin cross-reactivity rare < 1 %) + 3 consecutive days for refractory AOM<\/li>\n <li><strong>Azithromycin or clarithromycin - in case of severe allergy to beta-lactams:<\/strong> azithromycin 10 mg\/kg\/day \u00d7 3 days (or 10 mg\/kg D1 then 5 mg\/kg D2\u2013D5) + warning: high resistance of pneumococcus to macrolides in North America (20 to 40 %) \u2192 to be used only if proven allergy to beta-lactams<\/li>\n <li><strong>Painkillers - Absolute priority:<\/strong> paracetamol 15 mg\/kg every 4\u20136 hours (max 75 mg\/kg\/day) + ibuprofen 10 mg\/kg every 6\u20138 hours (if \u2265 6 months) \u2192 pain management is as important as antibiotic treatment + analgesic ear drops (lidocaine otic \u2014 Otigo\u00ae + Auralgan\u00ae) \u2192 rapid relief but short duration of action + do not use if tympanic membrane is perforated<\/li>\n <\/ul>\n\n <h2>Complications<\/h2>\n <ul class=\"co-list\">\n <li><strong>Acute mastoiditis<\/strong> Extension of infection to mastoid cells -> postauricular pain + swelling + postauricular erythema + pinna displaced forward and downward + high fever -> ENT emergency + hospitalization + IV antibiotics + surgical drainage if subperiosteal abscess<\/li>\n <li><strong>Meningitis:<\/strong> The most serious and frequent complication in infants, characterized by neck stiffness, bulging fontanelle, extreme irritability, and photophobia, indicates a neurological emergency requiring immediate hospitalization.<\/li>\n <li><strong>Facial paralysis<\/strong> Extension of infection to the fallopian canal (bony canal of the facial nerve traversing the mastoid) \u2192 ipsilateral peripheral facial paralysis \u2192 ENT emergency<\/li>\n <li><strong>Labyrinthitis<\/strong> Extension to the cochlea and vestibule \u2192 Vertigo + nausea + vomiting + sensorineural hearing loss \u2192 ENT emergency<\/li>\n <li><strong>Cholesteatoma<\/strong> long-term complication of recurrent otitis media with tympanic retractions \u2192 formation of invasive keratinizing epithelium in the middle ear \u2192 progressive destruction of ossicles, mastoid, and facial canal \u2192 tympanoplasty surgery<\/li>\n <\/ul>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Situations requiring urgent medical assessment<\/div>\n <p>Go immediately to the pediatric emergency room if an ear infection is accompanied by swelling and redness behind the earlobe with the earlobe protruding forward (mastoiditis) + stiff neck + bulging fontanelle in an infant + facial paralysis + intense dizziness + or very high fever with altered general condition in a child under 6 months old \u2014 these signs indicate a complication of otitis media requiring urgent hospital care.<\/p>\n <p>For the diagnosis of acute otitis media by otoscopy, the prescription of antibiotics according to age and severity criteria, and the follow-up of children with recurrent otitis, Clinique Omicron offers medical consultations at its service points in Quebec and via telemedicine. To make an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron's physician assistants (PAs) and nurse practitioners (NPs) diagnose acute otitis media using otoscopy and a pneumatic otoscope, apply age and severity criteria to decide on antibiotic therapy or active surveillance, prescribe optimal-dose amoxicillin or amoxicillin-clavulanate depending on the context, ensure follow-up at 48\u201372 hours if active surveillance is chosen, and refer children with recurrent ear infections to pediatric ENT. Consultations are available at multiple service points in Quebec and via telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is provided for informational purposes only and does not substitute for the advice of a doctor or pediatrician. The diagnosis of acute otitis media requires an otoscopy performed by a trained healthcare professional\u2014antibiotic treatment should not be prescribed without otoscopic diagnostic confirmation to prevent antibiotic overuse and the emergence of bacterial resistance.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Otite moyenne aigu\u00eb : sympt\u00f4mes, antibiotiques et traitement | Clinique Omicron P\u00e9diatrie & Oto-rhino-laryngologie & M\u00e9decine de famille Otite moyenne aigu\u00eb (OMA) L’otite moyenne aigu\u00eb (OMA) est une infection aigu\u00eb de l’oreille moyenne \u2014 la cavit\u00e9 close d\u00e9limit\u00e9e par le tympan en avant, la masto\u00efde en arri\u00e8re et la trompe d’Eustache en bas \u2014 constituant… <a href=\"https:\/\/cliniqueomicron.ca\/en\/otite\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Acute Otitis Media: Symptoms, Antibiotics, and Treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Otite moyenne aigu\u00eb : sympt\u00f4mes, | Brossard | Clinique Omicron","_metasync_otto_description":"L'otite moyenne aigu\u00eb est la plus fr\u00e9quente des infections bact\u00e9riennes de l'enfant. Tympan bombant, crit\u00e8res d'antibioth\u00e9rapie selon l'\u00e2ge, amoxicilline 90...","_metasync_otto_keywords":"","_metasync_otto_og_title":"Otite moyenne aigu\u00eb : sympt\u00f4mes, | Brossard | Clinique Omicron","_metasync_otto_og_description":"L'otite moyenne aigu\u00eb est la plus fr\u00e9quente des infections bact\u00e9riennes de l'enfant. Tympan bombant, crit\u00e8res d'antibioth\u00e9rapie selon l'\u00e2ge, amoxicilline 90...","_metasync_otto_twitter_title":"Otite moyenne aigu\u00eb : sympt\u00f4mes, | Brossard | Clinique Omicron","_metasync_otto_twitter_description":"L'otite moyenne aigu\u00eb est la plus fr\u00e9quente des infections bact\u00e9riennes de l'enfant. 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Tympan bombant, crit\u00e8res d'antibioth\u00e9rapie selon l'\u00e2ge, amoxicilline 90 mg\/kg, surveillance active et masto\u00efdite au Qu\u00e9bec.","_metasync_seo_title":"","_metasync_seo_desc":"","_metasync_breadcrumb_title":"","_metasync_primary_category":0,"_metasync_primary_product_cat":0,"_metasync_otto_disabled":"","_metasync_hreflang":"","_metasync_plugin_sync_ts":"{\"aioseo\":\"2026-05-10T07:39:30+00:00\"}","_metasync_robots_advanced":"","footnotes":""},"class_list":["post-24843","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/cliniqueomicron.ca\/en\/wp-json\/wp\/v2\/pages\/24843","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cliniqueomicron.ca\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/cliniqueomicron.ca\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/cliniqueomicron.ca\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cliniqueomicron.ca\/en\/wp-json\/wp\/v2\/comments?post=24843"}],"version-history":[{"count":4,"href":"https:\/\/cliniqueomicron.ca\/en\/wp-json\/wp\/v2\/pages\/24843\/revisions"}],"predecessor-version":[{"id":30897,"href":"https:\/\/cliniqueomicron.ca\/en\/wp-json\/wp\/v2\/pages\/24843\/revisions\/30897"}],"wp:attachment":[{"href":"https:\/\/cliniqueomicron.ca\/en\/wp-json\/wp\/v2\/media?parent=24843"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}

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\n\t\t\t\t\t\n\n\n\n\nAcute Otitis Media: Symptoms, Antibiotics, and Treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Acute otitis media is the most common pediatric bacterial infection. Otoscopic diagnosis, antibiotic therapy criteria, amoxicillin, and surveillance in Quebec.\">\n<meta name=\"keywords\" content=\"otite moyenne aigu\u00eb, OMA, otite moyenne aigu\u00eb enfant, otite moyenne aigu\u00eb traitement, amoxicilline otite, otite moyenne aigu\u00eb antibiotiques, otite moyenne aigu\u00eb diagnostic, otoscopie OMA, otite r\u00e9cidivante, otite moyenne aigu\u00eb Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n@import url('https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap');\n\n.co-wrap * {\n font-family: 'Poppins', sans-serif;\n box-sizing: border-box;\n}\n.co-wrap {\n max-width: 1100px;\n margin: 0 auto;\n padding: 30px 0 60px;\n margin-top: 10px;\n}\n.co-label {\n font-family: 'Cinzel', serif;\n font-size: 14px;\n font-weight: bold;\n letter-spacing: 1px;\n text-transform: uppercase;\n color: #4D6577;\n margin-bottom: 14px;\n display: block;\n}\n.co-wrap h1 {\n font-size: 32px;\n font-weight: 500;\n color: #323C52;\n margin: 0 0 22px;\n line-height: 1.2;\n letter-spacing: 0.5px;\n}\n.co-intro {\n font-size: 16px;\n font-weight: 400;\n line-height: 1.75;\n color: #4D6577;\n margin-bottom: 36px;\n padding-bottom: 32px;\n border-bottom: 1px solid rgba(77,101,119,.2);\n}\n.co-wrap h2 {\n font-size: 20px;\n font-weight: 600;\n color: #323C52;\n margin: 32px 0 12px;\n letter-spacing: 0.3px;\n}\n.co-wrap p {\n font-size: 15px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.7;\n margin-bottom: 14px;\n}\n.co-list {\n list-style: none;\n padding: 0;\n margin: 12px 0 24px;\n}\n.co-list li {\n font-size: 15px;\n font-weight: 400;\n color: #4D6577;\n padding: 10px 14px 10px 38px;\n margin-bottom: 8px;\n border-radius: 6px;\n position: relative;\n background: rgba(77,101,119,.06);\n border-left: 3px solid #4D6577;\n}\n.co-list li::before {\n content: \"\u2713\";\n position: absolute;\n left: 12px;\n font-weight: 700;\n color: #4D6577;\n}\n.co-table {\n width: 100%;\n border-collapse: collapse;\n margin: 14px 0 22px;\n font-size: 14px;\n border-radius: 8px;\n overflow: hidden;\n}\n.co-table thead tr {\n background: #323C52;\n color: #fff;\n}\n.co-table thead th {\n padding: 11px 16px;\n text-align: left;\n font-weight: 600;\n font-size: 13px;\n}\n.co-table tbody tr:nth-child(even) {\n background: rgba(77,101,119,.06);\n}\n.co-table tbody tr:nth-child(odd) {\n background: #fff;\n}\n.co-table td {\n padding: 10px 16px;\n color: #4D6577;\n border-bottom: 1px solid rgba(77,101,119,.12);\n font-size: 14px;\n vertical-align: top;\n}\n.co-table td:first-child {\n font-weight: 600;\n color: #323C52;\n}\n.co-infobox {\n display: flex;\n gap: 12px;\n background: rgba(77,101,119,.06);\n border-radius: 8px;\n border-left: 4px solid #4D6577;\n padding: 14px 18px;\n margin: 18px 0 28px;\n font-size: 14px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.65;\n}\n.co-infobox .ico {\n font-size: 18px;\n flex-shrink: 0;\n}\n.co-urgence {\n background: #fff8f8;\n border-left: 5px solid #c0392b;\n border-radius: 6px;\n padding: 20px 26px;\n margin: 24px 0 32px;\n}\n.co-urgence .co-urgence-titre {\n font-size: 13px;\n font-weight: 700;\n color: #c0392b;\n letter-spacing: 1.5px;\n text-transform: uppercase;\n margin-bottom: 10px;\n}\n.co-urgence p {\n color: #5a2020;\n font-size: 14px;\n margin: 0 0 10px;\n line-height: 1.7;\n}\n.co-urgence p:last-child {\n margin-bottom: 0;\n}\n.co-disclaimer {\n font-size: 13px;\n color: #8a9aaa;\n font-style: italic;\n border-top: 1px solid rgba(77,101,119,.15);\n padding-top: 24px;\n margin-top: 40px;\n line-height: 1.6;\n}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n\n <span class=\"co-label\">Pediatrics & Otolaryngology & Family Medicine<\/span>\n <h1>Acute otitis media (AOM)<\/h1>\n\n <div class=\"co-intro\">\n Acute otitis media (AOM) is an acute infection of the middle ear - the enclosed cavity bounded by the eardrum at the front, the mastoid at the back and the Eustachian tube at the bottom - constituting the most frequent bacterial infection in children and the leading cause of antibiotic prescriptions in pediatrics in industrialized countries. It affects around 80 % of children under the age of 3, with peak incidence between 6 and 24 months, coinciding with the period of daycare attendance, incomplete immunological maturation and maximum tubal vulnerability. The pathophysiology is a virtually constant progression from a viral infection of the upper respiratory tract (rhinovirus, respiratory syncytial virus, influenza), which causes inflammation and dysfunction of the Eustachian tube - the canal that ensures ventilation and drainage of the middle ear - to bacterial superinfection of the obstructed airspace of the tympanic case, with bacteria colonizing the nasopharynx, taking advantage of the tubal obstruction to ascend into the middle ear. The three main bacterial agents are <em>Streptococcus pneumoniae<\/em> (30 to 40 % of cases), <em>Haemophilus influenzae<\/em> non-typable (30 to 40 %) and <em>Moraxella catarrhalis<\/em> (10 to 15 %). The diagnosis is clinical and otoscopic\u2014diagnosis confirmation relies on direct visualization of a bulging, hyperemic, and opaque tympanic membrane, with loss of the light reflex. The main therapeutic challenge is to define whether antibiotic therapy is necessary\u2014spontaneous resolution occurring in 80 to 90 %of children over 2 years of age with non-severe AOM\u2014or if close monitoring without antibiotics is appropriate, as part of a strategy to preserve antibiotic resistance.\n <\/div>\n\n <h2>Pathophysiology and risk factors<\/h2>\n <ul class=\"co-list\">\n <li><strong>Central role of the Eustachian tube:<\/strong> Upper airway viral infection -> inflammation of the nasopharyngeal mucosa -> edema and tubal obstruction -> negative pressure in the tympanic cavity -> aspiration of nasopharyngeal secretions containing pathogenic bacteria -> bacterial multiplication in a closed, unventilated environment -> suppuration -> bulging, hyperemic, and painful eardrum<\/li>\n <li><strong>Child Anatomical Vulnerability<\/strong> Eustachian tube is shorter, more horizontal, less rigid, and opens less effectively during swallowing than in adults, explaining the peak prevalence between 6 months and 3 years. As the child grows and the tube lengthens and becomes more oblique, the frequency of OMAs (otitis media acute) spontaneously decreases.<\/li>\n <li><strong>Primary risk factors:<\/strong> Attending daycare (risk x 2-3 - increased exposure to viruses and bacteria) + bottle feeding in a reclined position (milk reflux into the eustachian tube) + passive smoking (impairment of tubal mucociliary transport) + formula feeding vs. breastfeeding (breast milk protects via secretory IgA and macrophages) + family history of recurrent AOM + cleft palate (congenital tubal dysfunction) + immunosuppression<\/li>\n <\/ul>\n\n <h2>Diagnostics \u2014 Clinical and Otoscopic Criteria<\/h2>\n <ul class=\"co-list\">\n <li><strong>Functional signs<\/strong> Acute unilateral ear pain (young child who cannot verbalize pain pulls at ear + cries + is irritable + sleeps poorly + refuses to feed or eat due to worsening pain with swallowing) + fever (present in 50 to 75 % of cases \u2014 but otitis media can exist without fever) + temporary hearing loss + sometimes purulent otorrhea if spontaneous tympanic membrane perforation (paradoxically favorable sign \u2014 pain is often relieved) + absence of tragus pain (unlike external otitis)<\/li>\n <li><strong>Otoscopy \u2014 positive diagnostic criteria:<\/strong> Bulging eardrum (convex towards the canal) + or opaque + hyperemic + with loss of the light reflex and normal landmarks + or purulent effusion visible behind the eardrum \u2192 simultaneous presence of effusion AND acute inflammation of the eardrum = certain acute otitis media + pneumatic otoscopy (eardrum mobility test under pressure) improves diagnostic accuracy (reduced mobility = effusion) + tympanometry (flat curve = type B) confirms effusion<\/li>\n <li><strong>OMA certain vs probable vs otitis media with effusion<\/strong> ACUTE OTITIS MEDIA (AOM) certain: bulging + hyperemic + opaque tympanic membrane + fever + ear pain + PROBABLE AOM: slightly pink or opaque tympanic membrane + mild changes without frank bulging + OTITIS MEDIA WITH EFFUSION (OME): non-inflamed tympanic membrane + effusion without acute signs + no fever or ear pain \u2192 do not treat with antibiotics<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span>The distinction between acute otitis media (AOM) and otitis media with effusion (OME\u2014effusion without acute inflammation) is fundamental because their treatments differ radically: AOM may warrant antibiotics depending on age and severity criteria, whereas OME should never be treated with antibiotics (no demonstrated benefit + increased resistance). The pneumatic otoscope is the most effective tool for this distinction\u2014to be used systematically in children with ear pain.<\/span>\n <\/div>\n\n <h2>Therapeutic decision \u2014 who to treat with antibiotics?<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Clinical situation<\/th>\n <th>Therapeutic recommendation<\/th>\n <th>Justification<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Infant < 6 months with certain or probable acute otitis media<\/td>\n <td>Systemic antibiotic therapy from the outset, without delay + hospitalization if general condition is altered or temperature is high<\/td>\n <td>High risk of serious complications (meningitis + mastoiditis) + immune immaturity + less frequent spontaneous resolution in this age group<\/td>\n <\/tr>\n <tr>\n <td>Child 6 months to 2 years with definite bilateral otitis media<\/td>\n <td>Empirical antibiotic therapy + amoxicillin 80\u201390 mg\/kg\/day in 2 doses \u00d7 10 days<\/td>\n <td>Bilateral OMA is associated with a higher risk of spontaneous resolution and complications + the 2013 AAP and 2016 SCP recommendations advocate for upfront antibiotic therapy.<\/td>\n <\/tr>\n <tr>\n <td>Child 6 months to 2 years with severe unilateral OMA (fever \u2265 39\u00b0C or severe otalgia)<\/td>\n <td>Empirical antibiotic therapy<\/td>\n <td>Clinical severity \u2192 antibiotic therapy without delay for pain control and prevention of complications<\/td>\n <\/tr>\n <tr>\n <td>Child 6 months to 2 years with unilateral, non-severe acute otitis media<\/td>\n <td>Option 1: immediate antibiotic therapy + Option 2: active observation (watchful waiting) for 48\u201372 hours with deferred antibiotic prescription + if worsening or no improvement \u2192 start antibiotics<\/td>\n <td>80% % spontaneous resolution in children over 6 months with unilateral non-severe AOM + reduced antibiotic consumption without increased complications in randomized trials<\/td>\n <\/tr>\n <tr>\n <td>Child \u2265 2 years old with non-severe acute otitis media (unilateral or bilateral)<\/td>\n <td>Active observation (watchful waiting) recommended first-line + analgesia + delayed prescription given to parents if worsening<\/td>\n <td>Spontaneous resolution in 80-90 % of cases + reduction of antibiotic side effects (diarrhea + candidiasis + allergy) + preservation of flora + reduction of antibiotic resistance<\/td>\n <\/tr>\n <tr>\n <td>OMA with purulent otorrhea (perforation)<\/td>\n <td>Empirical oral antibiotic therapy + local antibiotic ear drops (ciprofloxacin) if abundant discharge<\/td>\n <td>Tympanic perforation indicates active bacterial AOM, and otorrhea facilitates access of topical antibiotics to the middle ear.<\/td>\n <\/tr>\n <tr>\n <td>Recurrent OMA (\u2265 3 episodes in 6 months or \u2265 4 in 12 months)<\/td>\n <td>Focus on pediatric ENT for discussion of tympanostomy tubes (TT) + no long-term prophylactic antibiotics (not recommended)<\/td>\n <td>Antimicrobial Treatments reduce the number of recurrent OMA episodes by 50-60% % whereas prophylactic antibiotic therapy exposes to resistance without clear benefit.<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Antibiotic therapy \u2014 choice and dosage<\/h2>\n <ul class=\"co-list\">\n <li><strong>Amoxicillin \u2014 first choice:<\/strong> 80 to 90 mg\/kg\/day orally in 2 divided doses \u00d7 10 days (child < 2 years) or \u00d7 5 to 7 days (child \u2265 2 years with non-severe OMA) + optimal pneumococcal coverage including penicillin-non-susceptible *Streptococcus pneumoniae* (PNSP) strains thanks to high doses + advantages: narrow spectrum + well-tolerated + inexpensive + available as syrup<\/li>\n <li><strong>Amoxicillin-clavulanate (Clavulin\u00ae) \u2014 if failure at 48\u201372 hours or if recent antibiotic therapy (< 30 days):<\/strong> 90 mg\/kg\/day amoxicillin + 6.4 mg\/kg\/day clavulanate in 2 doses \u00d7 10 days + indicated for amoxicillin-resistant AOM (beta-lactamase-producing strains of'<em>H. influenzae<\/em> or <em>M. catarrhalis<\/em>) + more frequent digestive side effects (diarrhea)<\/li>\n <li><strong>Ceftriaxone IM 50 mg\/kg single dose (max 1 g) \u2014 if vomiting or true penicillin allergy:<\/strong> Very effective against pneumococcus + good option if the child cannot take orally + or if there is a documented penicillin allergy (check the type of allergy \u2014 penicillin-cephalosporin cross-reactivity rare < 1 %) + 3 consecutive days for refractory AOM<\/li>\n <li><strong>Azithromycin or clarithromycin - in case of severe allergy to beta-lactams:<\/strong> azithromycin 10 mg\/kg\/day \u00d7 3 days (or 10 mg\/kg D1 then 5 mg\/kg D2\u2013D5) + warning: high resistance of pneumococcus to macrolides in North America (20 to 40 %) \u2192 to be used only if proven allergy to beta-lactams<\/li>\n <li><strong>Painkillers - Absolute priority:<\/strong> paracetamol 15 mg\/kg every 4\u20136 hours (max 75 mg\/kg\/day) + ibuprofen 10 mg\/kg every 6\u20138 hours (if \u2265 6 months) \u2192 pain management is as important as antibiotic treatment + analgesic ear drops (lidocaine otic \u2014 Otigo\u00ae + Auralgan\u00ae) \u2192 rapid relief but short duration of action + do not use if tympanic membrane is perforated<\/li>\n <\/ul>\n\n <h2>Complications<\/h2>\n <ul class=\"co-list\">\n <li><strong>Acute mastoiditis<\/strong> Extension of infection to mastoid cells -> postauricular pain + swelling + postauricular erythema + pinna displaced forward and downward + high fever -> ENT emergency + hospitalization + IV antibiotics + surgical drainage if subperiosteal abscess<\/li>\n <li><strong>Meningitis:<\/strong> The most serious and frequent complication in infants, characterized by neck stiffness, bulging fontanelle, extreme irritability, and photophobia, indicates a neurological emergency requiring immediate hospitalization.<\/li>\n <li><strong>Facial paralysis<\/strong> Extension of infection to the fallopian canal (bony canal of the facial nerve traversing the mastoid) \u2192 ipsilateral peripheral facial paralysis \u2192 ENT emergency<\/li>\n <li><strong>Labyrinthitis<\/strong> Extension to the cochlea and vestibule \u2192 Vertigo + nausea + vomiting + sensorineural hearing loss \u2192 ENT emergency<\/li>\n <li><strong>Cholesteatoma<\/strong> long-term complication of recurrent otitis media with tympanic retractions \u2192 formation of invasive keratinizing epithelium in the middle ear \u2192 progressive destruction of ossicles, mastoid, and facial canal \u2192 tympanoplasty surgery<\/li>\n <\/ul>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Situations requiring urgent medical assessment<\/div>\n <p>Go immediately to the pediatric emergency room if an ear infection is accompanied by swelling and redness behind the earlobe with the earlobe protruding forward (mastoiditis) + stiff neck + bulging fontanelle in an infant + facial paralysis + intense dizziness + or very high fever with altered general condition in a child under 6 months old \u2014 these signs indicate a complication of otitis media requiring urgent hospital care.<\/p>\n <p>For the diagnosis of acute otitis media by otoscopy, the prescription of antibiotics according to age and severity criteria, and the follow-up of children with recurrent otitis, Clinique Omicron offers medical consultations at its service points in Quebec and via telemedicine. To make an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron's physician assistants (PAs) and nurse practitioners (NPs) diagnose acute otitis media using otoscopy and a pneumatic otoscope, apply age and severity criteria to decide on antibiotic therapy or active surveillance, prescribe optimal-dose amoxicillin or amoxicillin-clavulanate depending on the context, ensure follow-up at 48\u201372 hours if active surveillance is chosen, and refer children with recurrent ear infections to pediatric ENT. Consultations are available at multiple service points in Quebec and via telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is provided for informational purposes only and does not substitute for the advice of a doctor or pediatrician. The diagnosis of acute otitis media requires an otoscopy performed by a trained healthcare professional\u2014antibiotic treatment should not be prescribed without otoscopic diagnostic confirmation to prevent antibiotic overuse and the emergence of bacterial resistance.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Otite moyenne aigu\u00eb : sympt\u00f4mes, antibiotiques et traitement | Clinique Omicron P\u00e9diatrie & Oto-rhino-laryngologie & M\u00e9decine de famille Otite moyenne aigu\u00eb (OMA) L’otite moyenne aigu\u00eb (OMA) est une infection aigu\u00eb de l’oreille moyenne \u2014 la cavit\u00e9 close d\u00e9limit\u00e9e par le tympan en avant, la masto\u00efde en arri\u00e8re et la trompe d’Eustache en bas \u2014 constituant… <a href=\"https:\/\/cliniqueomicron.ca\/en\/otite\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Acute Otitis Media: Symptoms, Antibiotics, and Treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Otite moyenne aigu\u00eb : sympt\u00f4mes, | Brossard | Clinique Omicron","_metasync_otto_description":"L'otite moyenne aigu\u00eb est la plus fr\u00e9quente des infections bact\u00e9riennes de l'enfant. 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Tympan bombant, crit\u00e8res d'antibioth\u00e9rapie selon l'\u00e2ge, amoxicilline 90 mg\/kg, surveillance active et masto\u00efdite au Qu\u00e9bec.","_metasync_seo_title":"","_metasync_seo_desc":"","_metasync_breadcrumb_title":"","_metasync_primary_category":0,"_metasync_primary_product_cat":0,"_metasync_otto_disabled":"","_metasync_hreflang":"","_metasync_plugin_sync_ts":"{\"aioseo\":\"2026-05-10T07:39:30+00:00\"}","_metasync_robots_advanced":"","footnotes":""},"class_list":["post-24843","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/cliniqueomicron.ca\/en\/wp-json\/wp\/v2\/pages\/24843","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cliniqueomicron.ca\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/cliniqueomicron.ca\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/cliniqueomicron.ca\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cliniqueomicron.ca\/en\/wp-json\/wp\/v2\/comments?post=24843"}],"version-history":[{"count":4,"href":"https:\/\/cliniqueomicron.ca\/en\/wp-json\/wp\/v2\/pages\/24843\/revisions"}],"predecessor-version":[{"id":30897,"href":"https:\/\/cliniqueomicron.ca\/en\/wp-json\/wp\/v2\/pages\/24843\/revisions\/30897"}],"wp:attachment":[{"href":"https:\/\/cliniqueomicron.ca\/en\/wp-json\/wp\/v2\/media?parent=24843"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}