Otitis Media Diagnosis

Aka: Otitis Media Diagnosis, Otitis Media Symptoms and Signs

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II. 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%

III. Signs: Tympanic Membrane Findings by Otoscopy

  1. See Otoscopy
  2. 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%
  3. 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
  4. Mobility
    1. TM Immobile by Pneumatic Otoscopy
      1. Test Sensitivity: 94%
      2. Test Specificity: 90%
      3. Positive Predictive Value: 78%
    2. Tympanometry
      1. Normal Tympanogram
        1. No Acute Otitis Media
      2. Middle Ear effusion
        1. Test Sensitivity: 90%
        2. Test Specificity: 80%
        3. Negative Predictive Value: 77%
      3. Precaution
        1. Only Otoscopy can distinguish Acute Otitis Media (AOM) from Otitis Media with Effusion (OME)

IV. Differential Diagnosis

  1. See Otalgia
  2. Serous Otitis Media (Otitis Media with Effusion)
  3. Cerumen Impaction
  4. Ear Canal Foreign Body
  5. Otitis Externa
  6. Suppurative Otitis Media
  7. Eustachian Tube Dysfunction (often with Upper Respiratory Infection)
  8. Ear Barotrauma

V. Images

  1. EntTympanicMembraneNormal.jpg
  2. EntAcuteOtitisMedia.jpg

VI. References

  1. Thomas and Kosoko (2022) Crit Dec Emerg Med 36(12): 12-3
  2. Gaddey (2019) Am Fam Physician 100(6): 350-6 [PubMed]
  3. Kaleida (1992) Am J Dis Child 146:433-5 [PubMed]
  4. Hayden (1985) Am J Dis Child 139:721-3 [PubMed]
  5. Heikkinen (1995) Arch Pediatr Adolesc Med 149:26-9 [PubMed]
  6. Howie (1970) Pediatrics 45:29-35 [PubMed]
  7. Ruuskanen (1994) Pediatr Infect Dis J 13:S23-6 [PubMed]
  8. Weiss (1996) Am Fam Physician 53(4):1200-6 [PubMed]

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Ontology: Acute suppurative otitis media (C0271431)

Concepts Disease or Syndrome (T047)
ICD9 382.0
ICD10 H66.0
SnomedCT 42337005, 155226009, 194283000, 194281003
English ASOM, Acute supp. otitis media NOS, Acute suppurative otitis media NOS, acute suppurative otitis media (diagnosis), acute suppurative otitis media, Otitis media suppurative acute, Otitis media suppurative acute NOS, Otitis media;suppurative;acute, acute purulent otitis media, Acute suppurative otitis media NOS (disorder), Acute purulent otitis media, ASOM - Acute suppurative otitis media, Acute suppurative otitis media (disorder), otitis; media, acute, purulent, otitis; media, acute, suppurative, otitis; media, purulent, acute, otitis; media, suppurative, acute, suppurative; otitis media, acute, Acute suppurative otitis media, NOS, Acute suppurative otitis media (disorder) [Ambiguous], Acute otitis media, purulent, Acute suppurative otitis media
Dutch otitis media etterend acuut, etterende otitis media acuut NAO, acute etterende otitis media, etterig; otitis media, acuut, otitis; media, acuut, etterig, otitis; media, acuut, purulent, otitis; media, etterig, acuut, otitis; media, purulent, acuut, Acute etterige otitis media
French Otite moyenne suppurée aiguë, Otite moyenne suppurée aiguë SAI
German akute eitrige Otitis media, Otitis media eitrig akut NNB, Otitis media eitrig akut, Akute eitrige Otitis media
Italian Otite media suppurativa acuta, Otite media acuta suppurativa, Otite media suppurativa acuta NAS
Portuguese Otite média purulenta aguda, Otite média supurativa aguda NE
Spanish Otitis media purulenta aguda NEOM, Otitis media supurativa aguda, Otitis media aguda supurativa, otitis media aguda supurativa, SAI, otitis media aguda supurativa, SAI (trastorno), otitis media aguda purulenta, otitis media aguda supurativa (concepto no activo), otitis media aguda supurativa (trastorno), otitis media aguda supurativa
Japanese 急性化膿性中耳炎, 急性化膿性中耳炎ＮＯＳ, ｷｭｳｾｲｶﾉｳｾｲﾁｭｳｼﾞｴﾝNOS, ｷｭｳｾｲｶﾉｳｼｮｳﾁｭｳｼﾞｴﾝ, ｷｭｳｾｲｶﾉｳｾｲﾁｭｳｼﾞｴﾝ
Czech Akutní hnisavá otitis media, Akutní hnisavá otitis media NOS
Korean 급성 화농성 중이염
Hungarian heveny gennyes középfülgyulladás, Otitis media suppurativa acuta, Otitis media suppurativa acuta k.m.n.
Derived from the NIH UMLS (Unified Medical Language System)

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