Clinical Presentation
Signs and Symptoms
Otitis Media - Acute_Initial Assesment 1
In adults, acute otitis media is often preceded by an upper respiratory tract infection (URTI) or exacerbation of seasonal allergic rhinitis. Symptoms of URTI include cough, nasal discharge or stuffiness, and sore throat. This is commonly unilateral and includes otalgia, otorrhea with or without fever, diminished hearing, and disequilibrium. Purulent otorrhea may be observed if the tympanic membrane is ruptured.
History
Diagnosis requires a history of acute onset of signs and symptoms, and physical examination findings of middle ear inflammation and middle ear effusion through otoscopy. History alone is a poor predictor of the presence of acute otitis media. Signs and symptoms are usually non-specific. Viral URTI symptoms may be present before or during acute otitis media.
Physical Examination
Otitis Media - Acute_Initial Assesment 2
Middle Ear Inflammation
Middle ear inflammation is an apparent erythema of the tympanic membrane. Otalgia is apparent by noticeable discomfort of the ears that causes interference with or prevents normal sleep or activity.
Middle Ear Effusion
Middle ear effusion can be confirmed by direct visualization of the tympanic membrane by otoscopy or pneumatic otoscopy. The presence of middle ear effusion is indicated by any of the following: Bulging tympanic membrane with loss of normal landmarks; opacification or cloudiness of the tympanic membrane; absent or limited mobility of the tympanic membrane with pneumatic pressure; otorrhea (positive purulence is associated with rupture of the tympanic membrane); and air-fluid level behind the tympanic membrane.