Types: Acute Otitis Media: Middle ear infection Acute Otitis Externa: Outer ear infection Causes: Acute Otitis Media: Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis Acute Otitis Externa: Staphylococcus aureus Pseudomonas aeruginosa Approach: Focused History and Examination Acute Otitis Media: History of discomfort: Non-verbal: Fussy, change in appetite, trouble sleeping, tugging, rubbing ear Verbal: New-onset pain, ear drainage, fever Symptoms of upper respiratory infection Physical examination: Otoscopy: Red and bulging tympanic membrane with or without purulent drainage, suggesting rupture of tympanic membrane Non-specific signs of inflammation Pneumatic otoscopy: Impaired mobility of tympanic membrane Assess each quadrant for: Position Odor Translucency Mobility Check temperature and degree of otalgia (ear pain): <39°C: Mild otalgia, non-severe acute otitis media ≥39°C: Present otalgia, acute otitis media Treatment and Management Under 2 years: Oral analgesics: Paracetamol: Observe with ibuprofen or acetaminophen OR: Oral antihistamines High dose amoxicillin: 90 mg/kg Divide into 2 daily doses 7 days Amoxicillin: If used for 30 days and there's still purulent discharge, consider adding penicillinase-resistant beta-lactamase inhibitor. Amoxicillin allergy: Switch to second-generation cephalosporins (e.g., cefdinir). Failure to improve: Use intramuscular ceftriaxone. Eustachian tube: Connects middle ear with nasopharyngeal cavity. AOM (Acute Otitis Media): More common in children due to shorter, straighter, and more horizontal Eustachian tube.