Expert AOM Management in Australian General Practice
This interactive tool translates the 2024 Australian AOM Clinical Monograph into a practical, point-of-care resource. It is designed to help you make rapid, evidence-based decisions for diagnosing and managing Acute Otitis Media in line with RACGP and Therapeutic Guidelines.
Diagnose with Confidence
Use the interactive checklist and differential diagnosis comparator to ensure accurate AOM diagnosis and avoid common pitfalls.
Tailor Treatment Plans
Access the dynamic management algorithm and integrated patient decision aid to generate guideline-adherent treatment plans.
Prevent Recurrence
Quickly review high-impact, modifiable risk factors and preventive strategies for effective patient counselling.
Diagnostic Masterclass
Accurate diagnosis is the cornerstone of effective AOM management. A definitive diagnosis requires evidence of both middle ear effusion (MEE) and acute inflammation. Use the tools below to confirm your diagnosis.
AOM Diagnostic Checklist
Confirm the presence of at least one sign from each category for a definitive diagnosis.
1. Middle Ear Effusion (MEE)
- Bulging Tympanic Membrane: The single most specific sign.
- Opaque TM with loss of landmarks.
- Air-fluid level or bubbles behind TM.
- New onset of otorrhoea (not from AOE).
- Reduced/absent mobility on pneumatic otoscopy.
2. Acute Middle Ear Inflammation
- Moderate to severe otalgia: Cardinal symptom, especially with recent onset (<48h).
- Distinct erythema of the TM (Note: a non-specific sign alone).
- In pre-verbal children: unexplained irritability, ear pulling, poor feeding.
Differential Diagnosis Comparator
Compare the key features of AOM, Otitis Media with Effusion (OME), and Acute Otitis Externa (AOE) to avoid common diagnostic errors.
| Feature | AOM | OME ("Glue Ear") | AOE ("Swimmer's Ear") |
|---|---|---|---|
| Key Symptom | Moderate-severe otalgia | Muffled hearing | Severe otalgia, itching |
| TM Appearance | Bulging, opaque | Retracted or neutral, dull | Obscured by canal swelling |
| Key Sign | Preceding URTI | Effusion without inflammation | Pain on tragal pressure |
| TM Mobility | Reduced / Absent | Reduced / Absent | Normal (if visible) |
Management Algorithm
Generate a guideline-adherent management plan. Start by providing adequate analgesia, then use the selector below to determine the appropriate antibiotic strategy.
Priority #1: Analgesia
The mainstay of AOM management is adequate and regular oral analgesia. This is the first-line intervention for every child. Advise parents to use age- and weight-appropriate doses of Paracetamol (15 mg/kg/dose) or Ibuprofen (10 mg/kg/dose).
GP Antibiotic Strategy Selector
Select all applicable patient risk factors to reveal the recommended management pathway. For children without clear high-risk factors, clinical judgement is key, especially for those aged 2 years or younger.
Select patient factors above to see the recommendation.
Shared Decision-Making Tool (for Patients & Carers)
Use this tool to discuss the likely benefits and harms of antibiotics for a middle ear infection with parents and carers, based on the ACSQHC Decision Aid.
How long does the earache last?
On average, children who take antibiotics have earache for only about 12 hours less than children who do not.
Possible Benefits
Out of 100 children, antibiotics help about 5 extra children get better by day 2-3.
100 children who DO NOT take antibiotics
100 children who DO take antibiotics
Possible Harms
Out of 100 children, about 7 extra children will have problems like vomiting, diarrhoea or a rash due to antibiotics.
100 children who DO NOT take antibiotics
100 children who DO take antibiotics
Questions for our discussion
- What happens if my child does not take antibiotics?
- Do I know enough about the benefits and harms of each option?
- Am I clear about which benefits and harms matter most to me and my child?
Red Flags: When to Seek Urgent Help
The presence of any of the following signs suggests a serious complication and mandates urgent referral to an Emergency Department or ENT specialist.
- Swelling, redness, or pain behind the ear
- Facial nerve palsy (new onset face droop)
- Severe vertigo, dizziness or nystagmus
- Signs of meningism (stiff neck, light sensitivity)
- Very drowsy, altered conscious state, or inconsolable
- Focal neurological signs (e.g. new weakness)
- High fever (>38.5°C) that doesn't improve
- Cold or discoloured hands/feet with a warm body
Prevention & Recurrent AOM
For families burdened by recurrent AOM (≥3 episodes in 6 months or ≥4 in 12 months), counselling on high-impact, modifiable risk factors is the most effective preventive strategy in primary care.
🚭 Avoid Passive Smoke
Strong evidence links environmental tobacco smoke exposure to an increased risk of AOM. This is a critical public health message for carers.
🤱 Promote Breastfeeding
Exclusive breastfeeding for at least the first six months of life has a protective effect against the development of early AOM.
🍼 Limit Pacifier Use
Advise limiting pacifier (dummy) use, particularly after 6-12 months of age, as it is associated with an increased risk of AOM.
💉 Ensure Vaccinations
Ensure the child is up-to-date with the National Immunisation Program schedule, including Pneumococcal (PCV) and annual Influenza vaccines.
🤝 Specialist Referral
Consider ENT referral for children with debilitating rAOM for consideration of tympanostomy tubes (grommets).
💊 Prophylactic Antibiotics
Generally not recommended for most children due to resistance risks. Primarily reserved for high-risk populations (e.g., Aboriginal/TSI children) under specialist guidance.