The term otitis media (OM) has been used to describe multiple disorders of the middle ear, including acute otitis media (AOM), otitis media with effusion (OME), and chronic OME. This chapter uses the term otitis media in its historic usage as an umbrella term including acute otitis media and otitis media with effusion and uses the terms acute otitis media and otitis media with effusion as specific disease processes as defined below. The purpose of the chapter is to describe the contemporary approach to diagnosis and management of AOM and to discuss OME as it relates to AOM.
Otitis media with effusion is usually the result of AOM. Therefore, AOM and OME are pathologic processes along the same disease continuum. This relationship has resulted in diagnostic uncertainty and variations in the definition of AOM over time. However, establishing a uniform and appropriate definition, diagnostic criteria, and management schema is of utmost importance if AOM is to be diagnosed and managed appropriately.1,2 The most important distinction is that OME is not treated with antibiotics, whereas AOM may be treated with antibiotics.
With the above caveat in mind, the American Academy of Pediatrics (AAP) Subcommittee on Management of Acute Otitis Media and the Agency for Healthcare Research and Quality (AHRQ) have jointly established a definition of AOM.3–5 This definition requires the presence of three equally important elements:4
Acute onset (< 48 hours) of signs and symptoms
Middle-ear effusion (MEE)
Signs and symptoms of middle-ear inflammation.
Methods and criteria for the diagnosis of AOM pertaining to each of these diagnostic elements are included in the following sections and in Table 31-1.
TABLE 31-1Diagnostic Elements, Methods, and Criteria for Diagnosing Acute Otitis Media1 |Favorite Table|Download (.pdf) TABLE 31-1 Diagnostic Elements, Methods, and Criteria for Diagnosing Acute Otitis Media1
|Diagnostic Element ||Method ||Criteria |
|Acute onset ||History of illness ||< 48 hours |
|Middle ear effusion || |
Pneumatic otoscopy or
Bulging of the TM
Limited TM mobility
Air fluid level behind TM
|Middle ear inflammation ||History/physical exam ||At least one: fever, otalgia, irritability in infant, red TM not due to crying or fever2 |
In similar fashion, AAP has convened an expert panel to define and develop clinical practice guidelines for OME based on evidence review by AHRQ. Otitis media with effusion is defined as the presence of middle-ear fluid without signs or symptoms of AOM.1,6 Implicit in this definition is the absence of evidence of middle-ear inflammation. OME occurs without an inflammatory component as a result of eustachian tube dysfunction or, alternatively, during the period following AOM in which inflammation has resolved but effusion persists.
Acute otitis media, otitis media with effusion, and other processes constituting the designation otitis media are second only to upper respiratory infections as a reason ...