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OTITIS MEDIA - ACUTE (PEDIATRIC)
Otitis media is a general term used to describe inflammation of the middle ear which may be caused by an acute infection.
The symptoms are usually nonspecific and include otalgia (pulling of ear in an infant), irritability, otorrhea with or without fever.
Symptoms of upper respiratory tract infection may also be present

Diagnosis

  • Diagnosis of acute otitis media (AOM) requires a history of acute onset of signs & symptoms, confirmation of middle ear effusion (MEE) & signs & symptoms of middle ear inflammation
    • Acute onset is <3 weeks duration
Diagnosis is confirmed w/ the presence of the following:
  • Moderate to severe tympanic membrane bulging or new onset otorrhea not caused by acute otitis external
  • Mild tympanic membrane bulging & <48 hours onset of otalgia or severe erythema of the tympanic membrane

History

  • History alone is a poor predictor of the presence of acute otitis media
  • Signs & symptoms are usually nonspecific
  • Patient may have history of sudden onset of 1 or more of the following: Otalgia, otorrhea, fever, irritability, restless sleep
  • Patient may also present w/ facial nerve or 6th cranial nerve palsy
  • Viral upper respiratory tract infections & symptoms may be present before or during acute otitis media (AOM)

Physical Examination

Presence of Middle Ear Effusion (MEE)
  • MEE can be confirmed by direct visualization of the tympanic membrane by pneumatic otoscopy with or without tympanometry
  • Presence of MEE indicated by any of the following:
    • Absent or limited mobility of tympanic membrane (best predictor of acute otitis media) 
    • Bulging tympanic membrane w/ loss of normal landmarks
    • Markedly retracted tympanic membrane
    • Opacification, cloudiness or distinct redness of tympanic membrane
    • Absent or limited mobility of tympanic membrane
    • Otorrhea
    • Air-fluid level or air bubbles behind the tympanic membrane
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