Singapore
Search
Sign In
)
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
- 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 AOM
- 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 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 AOM)
- 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
