Complications of Acute Otitis Media in the Pediatric Population: Recognition, Management, and Prevention

Abstract

Acute otitis media (AOM) is one of the most common childhood infections and a leading reason for antibiotic prescriptions and urgent-care visits. Although most cases resolve without sequelae, a subset progresses to local suppurative disease, extracranial extension, intracranial infection, or long-term functional impairment. Complications are now uncommon in many high-income settings, but they remain clinically important because delayed recognition can lead to permanent hearing loss, neurodevelopmental impact, or life-threatening disease. This review summarizes the pathophysiology and epidemiology of AOM complications in children, classifies intratemporal, extracranial, and intracranial manifestations, and outlines contemporary approaches to diagnosis, imaging, and management. Particular attention is given to acute mastoiditis as the most frequent serious complication, facial nerve palsy, labyrinthitis, and cerebral venous sinus thrombosis. Finally, prevention strategies – including vaccination, accurate diagnosis, and antibiotic stewardship – are discussed.