Chart — Pediatrics
Otitis Media vs Otitis Externa Chart
Three ear problems, three different managements: the infected middle ear (AOM), the silent fluid (OME), and the inflamed canal (externa). One bedside move sorts the canal from the middle ear — press the tragus.
Educational use only. Antibiotic decisions, watchful-waiting criteria, and otic drop selection follow provider orders and current pediatric guidelines. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
The Three Side by Side
| Feature | Acute Otitis Media (AOM) | Otitis Media with Effusion (OME) | Otitis Externa |
|---|---|---|---|
| Where & what | Middle ear — infected fluid behind the eardrum | Middle ear — non-infected fluid (effusion) behind an intact eardrum | Ear canal — inflamed/infected canal skin ("swimmer's ear") |
| Typical cause / risk | After a viral URI; short horizontal eustachian tubes, daycare, bottle propping, smoke exposure | Follows AOM or chronic eustachian dysfunction; allergy season | Water trapped in the canal (swimming), cotton-swab trauma, hearing aids/earbuds |
| Hallmark findings | Rapid-onset ear pain (ear pulling, irritability, crying when flat), fever; bulging, red, poorly mobile TM | Painless; muffled hearing, fullness; retracted/neutral TM with fluid line or bubbles | Canal pain that's worse with chewing; PAIN WITH TRAGUS PRESSURE or pinna traction; itchy, swollen canal with drainage |
| Fever | Common | No | Uncommon/low-grade |
| Treatment | Pain management for all (weight-based acetaminophen/ibuprofen); high-dose amoxicillin when antibiotics indicated; watchful waiting for select mild cases | Observation — antibiotics don't help; hearing evaluation if persistent; tubes for chronic effusion with hearing loss | Topical antibiotic ± steroid drops; keep the canal dry; analgesia; wick if the canal is very swollen |
| Key teaching | Finish the course; feed upright, no bottle propping, no smoke exposure; vaccines current; worsening signs → call | Why "watch and wait" protects hearing AND avoids antibiotics; speech/hearing follow-up matters | Dry ears after swimming (tilt, towel, hairdryer on low); NO cotton swabs; earplugs per provider for frequent swimmers |
Exam Traps
- ✦Pain with tragus pressure or pinna traction = otitis EXTERNA; in AOM the outside of the ear doesn't hurt to touch.
- ✦OME is fluid WITHOUT infection — antibiotics are wrong; the concern is hearing during language development.
- ✦Pain relief comes first in AOM, with or without antibiotics — weight-based acetaminophen or ibuprofen, never aspirin in children.
- ✦Sudden pain relief plus new drainage in AOM = the eardrum ruptured.
- ✦Otic drops: pinna DOWN and back under 3 years, UP and back after — the perennial pediatric question.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Academy of Pediatrics (AAP) · CDC / ACIP (immunization schedule). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →