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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
- 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
