Otitis Media Diagnosis

Aka: Otitis Media Diagnosis

1. See Also
   1. Otitis Media
   2. Otitis Media Acute Treatment
2. 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%
3. 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%
4. Images
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5. References
   1. Kaleida (1992) Am J Dis Child 146:433-5
   2. Hayden (1985) Am J Dis Child 139:721-3
   3. Heikkinen (1995) Arch Pediatr Adolesc Med 149:26-9
   4. Howie (1970) Pediatrics 45:29-35
   5. Ruuskanen (1994) Pediatr Infect Dis J 13:S23-6
   6. Weiss (1996) Am Fam Physician 53(4):1200-6