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A 38-year-old man presents with right ear pain, hearing loss, and a sense of fullness for 3 days. He reports fever and mild dizziness. Otoscopy shows a bulging, erythematous tympanic membrane with reduced mobility. No discharge is noted. What is the stepwise evidence-based approach to diagnosing and managing acute otitis media in adults?
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Confirm diagnosis with bulging tympanic membrane
Start amoxicillin or amoxicillin-clavulanate as first-line therapy
Assess symptoms and perform otoscopic exam
Evaluate severity and systemic symptoms (fever, pain)
Avoid unnecessary antibiotics for viral or non-infectious causes
Consider watchful waiting in mild, non-severe cases
Offer analgesics (NSAIDs, acetaminophen) for symptom relief
Reassess if no improvement within 48–72 hours
Refer to ENT if recurrent or persistent otitis media
Educate on middle ear anatomy and eustachian tube function
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1
Assess symptoms and perform otoscopic exam
media1
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2
Confirm diagnosis with bulging tympanic membrane
media1
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3
Evaluate severity and systemic symptoms (fever, pain)
media1
pic1
4
Consider watchful waiting in mild, non-severe cases
media1
pic1
5
Start amoxicillin or amoxicillin-clavulanate as first-line therapy
media1
pic1
6
Offer analgesics (NSAIDs, acetaminophen) for symptom relief
media1
pic1
7
Avoid unnecessary antibiotics for viral or non-infectious causes
media1
pic1
8
Educate on middle ear anatomy and eustachian tube function
media1
pic1
9
Reassess if no improvement within 48–72 hours
media1
pic1
10
Refer to ENT if recurrent or persistent otitis media
media1
pic1
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Otitis Media
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