Diagnosis of otitis media: definitions and workup

Extract

• Diagnosis is based on ear findings and symptoms.
• The child should not unnecessarily be labelled as a ”chronic ear patient”. Wrong and uncertain diagnoses result in unnecessary courses of antibiotics and tympanostomy tube insertions.
• When examining otitis media, it is essential that the examiner is able to recognize the tympanic membrane landmarks (manubrium of malleus, umbo, light reflex).
• Acute otitis media (AOM) is an infectious disease associated with a respiratory tract infection or a common cold. A bulging tympanic membrane is the most reliable sign of bacterial infection of the middle ear. In a child with no symptoms of infection, AOM is highly unlikely.
• There may also be discharge in the middle ear during a common cold and always after an acute otitis media (2 weeks to 3 months) After acute otitis effusion is found in the middle ear for several weeks but disappears sooner when treated with antibiotics compared to placebo, at least in some children.A. In contrast to acute otitis media, the eardrum is concave or retracted. Mere discharge does not justify a diagnosis of acute otitis media or antimicrobial treatment.
• Pneumatic otoscopy and tympanometry Tympanometry1 provide indirect information on the presence of effusion, considerably improving the diagnostic accuracy.

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AOM, Child, Ear, Ear drum, Ear pain, H65, H66, H73, Infectious diseases, OME, Otitis, Otitis Media with Effusion, Otitis media, Otorhinolaryngology, Otoscopy, Paediatrics, Tympanometry