Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ Moderate to severe bulging of the tympanic membrane (TM) or new otorrhea not associated with otitis externa Mild bulging of the TM and less than 48 hours of otalgia (ear-holding, tugging, or rubbing in a nonverbal child) or intense erythema of the TM Middle ear effusion, proven by pneumatic otoscopy or tympanometry, must be present +++ General Considerations ++ Bacterial or viral pathogens can be detected in up to 96% of middle ear fluid samples from patients with AOM Polybacterial infections are seen in up to 55% of cases, with bacterial and viral coinfections occurring in up to 70% Causative bacteria Streptococcus pneumoniae and Haemophilus influenzae account for 35–40% and 30–35% of isolates, respectively Moraxella catarrhalis causes up to 15–25% of cases in the United States Streptococcus pyogenes is found more frequently in school-aged children than in infants Most common viruses associated with AOM Respiratory syncytial virus Influenza virus Adenovirus Human metapneumovirus Enteroviruses +++ Clinical Findings ++ Two findings are critical in establishing a diagnosis of AOM: a bulging TM and a middle ear effusion (MEE) The presence of MEE is best determined by visual examination and either pneumatic otoscopy or tympanometry In order to distinguish AOM from otitis media with effusion, signs and symptoms of middle ear inflammation and acute infection must be present Otoscopic findings specific for AOM include Bulging TM Impaired visibility of ossicular landmarks Yellow or white effusion (pus) Opacified and inflamed eardrum Squamous exudate or bullae on the eardrum +++ Differential Diagnosis ++ Otitis media with effusion Bullous myringitis Acute mastoiditis Middle ear mass +++ Diagnosis ++ Pneumatic otoscopy Can improve diagnostic ability by 15–25% The largest possible speculum should be used to provide an airtight seal and maximize the field of view When the rubber bulb is squeezed, the TM should move freely with a snapping motion; if fluid is present in the middle ear space, the mobility of the TM will be absent or resemble a fluid wave Tympanometry Can be helpful in assessing middle ear status, particularly when pneumatic otoscopy is inconclusive or difficult to perform Can reveal the presence or absence of a MEE but cannot differentiate between acutely infected fluid (AOM) and a chronic effusion (OME) Measures TM compliance as well as volume of ear canal, which can help differentiate between intact and perforated TM Standard 226-Hz tympanometry is not reliable in infants younger than 6 months;a high-frequency (1000 Hz) probe is used in this age group +++ Treatment ++ Pain management Mild to moderate pain should be treated with ibuprofen or acetaminophen Severe pain should be treated with opioids, but careful and close observation is required to address possible respiratory depression, altered mental status, gastrointestinal upset, and constipation Topical analgesics have ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessPediatrics 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessPediatrics Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options