Acute otitis media Acute otitis media is a bacterial or viral infection of the middle ear, usually accompanying an upper respiratory infection. Symptoms include otalgia (ear pain), often with systemic symptoms (eg, fever, nausea, vomiting, diarrhea), especially in the very young children. Diagnosis is based on otoscopy. Treatment is with analgesics and sometimes antibiotics. Although acute otitis media can occur at any age, it is most common between ages 3 months and 3 years. At this age, the eustachian tube is structurally and functionally immature—the angle of the eustachian tube is more horizontal, and the angle of the tensor veli palatini muscle and the cartilaginous eustachian tube renders the opening mechanism less efficient. Anything that causes the eustachian tubes to become swollen or blocked makes more fluid build up in the middle ear behind the eardrum. The cause of acute otitis media may be viral or bacterial. Viral infections are often complicated by secondary bacterial
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