How can I differentiate between OME and acute otitis media in a child presenting with ear symptoms?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
The primary way to differentiate between otitis media with effusion (OME) and acute otitis media (AOM) in a child presenting with ear symptoms is based on the presence of acute inflammation and the rapid onset of symptoms .
  • Otitis Media with Effusion (OME): This condition is characterised by the presence of fluid (effusion) in the middle ear space, but it occurs without signs of acute inflammation or infection . Children with OME often present with symptoms such as hearing difficulties (e.g., mishearing, difficulty in groups, asking for repetitions), delayed speech and language development, ear discomfort, or tinnitus . It is typically not associated with rapid onset of symptoms, pain, or fever ,.
  • Acute Otitis Media (AOM): AOM is defined by the presence of acute inflammation in the middle ear . It is accompanied by the rapid onset of symptoms and signs of an ear infection . AOM is typically associated with ear pain and/or fever .

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