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Patient Story

A 15-month-old boy is brought by both parents to his pediatrician with a 2-day history of fever, irritability, and frequent tugging of his left ear. This was preceded by a 1-week history of nasal congestion, cough, and rhinorrhea. On otoscopy, his left tympanic membrane (TM) appears erythematous, cloudy, bulging, and exudative (Figure 22-1). His left TM fails to move on pneumatic otoscopy. The physician diagnoses acute otitis media and decides with the parents to prescribe a 10-day course of amoxicillin; the child recovers uneventfully.


Acute otitis media in the left ear of a 15-month-old patient with marked erythema and bulging of the tympanic membrane. The malleus and light reflex are not visible. (Used with permission from William Clark, MD.)

In follow-up 2 months later, the child appears healthy and is meeting all his developmental milestones. On otoscopic examination, air–fluid levels are seen in the right ear (Figure 22-2). The physician explains the diagnosis of otitis media with effusion to the parents and arranges follow-up. Three months later the effusion is completely resolved.


Otitis media with effusion (OME) in the right ear. Note multiple air–fluid levels in this slightly retracted, translucent, nonerythematous tympanic membrane. (Used with permission from Frank Miller, MD.)


Acute otitis media (AOM) is the most common diagnosis for acute office visits for children.1 AOM is characterized by middle-ear effusion in a patient with signs and symptoms of acute illness (e.g., fever, irritability, otalgia). Otitis media with effusion (OME) is a disorder characterized by fluid in the middle ear in a patient without signs and symptoms of acute ear infection; it is also very common in childhood.


  • AOM accounted for $5 billion of the total national health expenditure in 2000; more than 40 percent was incurred for children between 1 and 3 years of age.1

  • It is estimated that 60 percent to 80 percent of children in the US develop AOM by 1 year of age and that 80 percent to 90 percent develop AOM by 2 to 3 years of age.2,3

  • The highest incidence occurs between 6 and 24 months of age.2,3

  • AOM is the most common reason for outpatient antibiotic treatment in the US.4 A national survey in 1992 revealed that 30 percent of all antibiotics prescribed for children younger than age 18 years was for treatment of AOM.5

  • OME is diagnosed in 2.2 million children yearly in the US.6

  • Approximately 90 percent of children (80% of individual ears) have OME at some time before school age, most often between ages 6 months and 4 years.6...

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