otitis%20media%20-%20acute%20(pediatric)
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

Otitis%20media%20-%20acute%20(pediatric) Diagnosis

Diagnosis

  • Diagnosis of acute otitis media (AOM) requires a history of acute onset of signs and symptoms, confirmation of middle ear effusion (MEE) and signs and symptoms of middle ear inflammation
    • Acute onset is <3 weeks duration
Diagnosis is confirmed with 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 and <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 and 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 with facial nerve or 6th cranial nerve palsy
  • Viral upper respiratory tract infections and 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 with 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

Pain Assessment

  • Depends on child’s cognitive, behavioral and relational development
  • Recommended pain scores include:
    • Infants and nonverbal children <3 years of age or those with motor or cognitive disorders involving pain perception: Face, Legs, Activity, Cry, Consolability (FLACC) pain assessment tool
    • Children >3 years old: Wong-Baker score
    • Children ≥8 years old: Numeric scale
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