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Otitis Media Diagnosis

See Also
1. Otitis Media
2. Otitis Media Acute Treatment
Symptoms (reference to Incidence in Otitis Media cases)
1. Ear Pain (Otalgia) (40-60%)
  1. Predicts <50% of Otitis Media
  2. Predicts 80% of Otitis Media in presence of URI
  3. Only 12% of children "pulling ear" have Otitis Media
  4. Other causes of Otalgia
    1. Upper Respiratory Infection
    2. Cerumen Impaction
    3. Sterile effusion
2. Rhinitis (90%)
3. Cough (78%)
4. Constitutional symptoms (60-80%)
  1. Ill Child
  2. Poor appetite
  3. Irritable
5. Low-grade fever (22-69%)
  1. Temperature under 101 degrees for <24 hours
6. Difficult sleeping in infants (35-50%)
7. Ear Drainage (5%)
  1. Liquefied cerumen from fever or
  2. Pus from perforated Tympanic Membrane
8. Unilateral Hearing Loss
9. Upper Respiratory Infection
  1. Incidence of Otitis Media after 5 days of URI: 40%
Signs: Tympanic Membrane Findings by Otoscopy
1. Color
  1. Cloudy, opacified tympanic membrane
    1. Positive Predictive Value: 80%
  2. Red tympanic membrane
    1. Multiple causes (Nonspecific finding)
      1. Crying
      2. Viral illness
    2. Positive Predictive Value
      1. Distinctly Red tympanic membrane: 65%
      2. Slightly Red tympanic membrane: 16%
2. Position
  1. Tympanic membrane bulging
    1. Positive Predictive Value: 89%
    2. First occurs in posterosuperior quadrant
    3. TM most compliant in posterosuperior quadrant
  2. Loss of landmarks (Cannot see Umbo) (80% PPV)
  3. Light reflex may be absent from bulging TM
3. Mobility
  1. TM Immobile by Pneumatic Otoscopy
    1. Positive Predictive Value: 78%
  2. Tympanometry
    1. Normal Tympanogram suggests no AOM
    2. Middle Ear effusion
      1. Test Sensitivity: 90%
      2. Test Specificity: 80%
      3. Negative Predictive Value: 77%
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References

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/16/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.