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Otitis Media Diagnosis

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Otitis Media Diagnosis, Otitis Media Symptoms and Signs

  • See Also
  1. Otitis Media
  2. Observation Protocol for Acute Otitis Media Management
  3. Otitis Media Acute Treatment
  4. Otalgia
  • Symptoms (reference to Incidence in Otitis Media cases)
  1. Ear Pain (Otalgia) (40-60%)
    1. Predicts <50% of Otitis Media
    2. Predicts 80% of Otitis Media in presence of URI
    3. Only 12% of children "pulling ear" have Otitis Media
    4. Other causes of Otalgia
      1. Upper Respiratory Infection
      2. Cerumen Impaction
      3. Sterile effusion
  2. Rhinitis (90%)
  3. Cough (78%)
  4. Constitutional symptoms (60-80%)
    1. Ill Child
    2. Poor appetite
    3. Irritable
  5. Low-grade fever (22-69%)
    1. Temperature under 101 degrees for <24 hours
  6. Difficult sleeping in infants (35-50%)
  7. Ear Drainage (5%)
    1. Liquefied cerumen from fever or
    2. Pus from perforated Tympanic Membrane
  8. Unilateral Hearing Loss
  9. Upper Respiratory Infection
    1. Incidence of Otitis Media after 5 days of URI: 40%
  1. See Otoscopy
  2. Color
    1. Cloudy, opacified Tympanic Membrane
      1. Positive Predictive Value: 80%
    2. Red Tympanic Membrane
      1. Multiple causes (Nonspecific finding)
        1. Crying
        2. Viral illness
      2. Positive Predictive Value
        1. Distinctly Red Tympanic Membrane: 65%
        2. Slightly Red Tympanic Membrane: 16%
  3. Position
    1. Tympanic Membrane bulging
      1. Positive Predictive Value: 89%
      2. First occurs in posterosuperior quadrant
      3. TM most compliant in posterosuperior quadrant
    2. Loss of landmarks (Cannot see Umbo) (80% PPV)
    3. Light reflex may be absent from bulging TM
  4. Mobility
    1. TM Immobile by Pneumatic Otoscopy
      1. Test Sensitivity: 94%
      2. Test Specificity: 90%
      3. Positive Predictive Value: 78%
    2. Tympanometry
      1. Normal Tympanogram
        1. No Acute Otitis Media
      2. Middle Ear effusion
        1. Test Sensitivity: 90%
        2. Test Specificity: 80%
        3. Negative Predictive Value: 77%
      3. Precaution
        1. Only Otoscopy can distinguish Acute Otitis Media (AOM) from Otitis Media with Effusion (OME)
  • Differential Diagnosis
  1. See Otalgia
  2. Serous Otitis Media (Otitis Media with Effusion)
  3. Cerumen Impaction
  4. Ear Canal Foreign Body
  5. Otitis Externa
  6. Suppurative Otitis Media
  7. Eustachian Tube Dysfunction (often with Upper Respiratory Infection)
  8. Ear Barotrauma
  • Images
  1. EntTympanicMembraneNormal.jpg
  2. EntAcuteOtitisMedia.jpg
  • References
  1. Thomas and Kosoko (2022) Crit Dec Emerg Med 36(12): 12-3
  2. Gaddey (2019) Am Fam Physician 100(6): 350-6 [PubMed]
  3. Kaleida (1992) Am J Dis Child 146:433-5 [PubMed]
  4. Hayden (1985) Am J Dis Child 139:721-3 [PubMed]
  5. Heikkinen (1995) Arch Pediatr Adolesc Med 149:26-9 [PubMed]
  6. Howie (1970) Pediatrics 45:29-35 [PubMed]
  7. Ruuskanen (1994) Pediatr Infect Dis J 13:S23-6 [PubMed]
  8. Weiss (1996) Am Fam Physician 53(4):1200-6 [PubMed]