Diagnosing acute otitis media

  • Sudden, piercing pain in the ear is the hallmark of an ear infection. The pain may be worse when lying down, making it difficult to sleep. Other symptoms include trouble hearing, fever, fluid drainage from ears, dizziness and congestion.

  • Colds, flu and allergies can irritate the Eustachian tube, the canal that connects the middle ear to the throat and maintains pressure levels in the ear, causing the passageways lining to become swollen. This can cause blockage and fluid to build up in the middle ear, creating a breeding ground for bacteria and viruses that can cause infection.

  • When too much fluid builds up in the middle ear, it can put pressure on the eardrum until it ruptures. Signs of a perforated eardrum include yellow, brown, or white fluid draining from the ear. Pain may disappear suddenly because the pressure of the fluid on the eardrum is gone.

  • The American Academy of Pediatrics has identified three criteria needed to diagnose AOM -- acute onset, middle ear effusion (MEE), and middle ear inflammation.This endoscopic view shows otitis media with effusion. It is not red, the short process of the malleus is visible, and therefore it is not bulging, and there is no opaqueness of the TM, all of which indicate AOM.

  • Pneumatic otoscopy -- a quick, painless test -- enables clinicians to detect MEE by measuring the mobility of a patient’s tympanic membrane in response to pressure changes. The otoscope blows a small amount of air at the eardrum, making the eardrum vibrate. If fluid is present, the eardrum will not move as much as it should.

  • AOM treatment varies depending upon the age and symptoms of the child. Antibiotics are recommended for children aged younger than 6 months, and in those aged 6 months and older with severe illness (moderate to severe otalgia with a fever of 102.2º F), whose diagnosis is certain.

  • For those with nonsevere illness, the AAP recommends observation, but warns this option is appropriate only when follow-up can be ensured, and antibacterial agents can be started if symptoms persist or worsen. Remedies to ease pain associated with ear infections include OTC painkillers, eardrops and applying a warm washcloth or heating pad.

  • Children who have recurring bouts of otitis media should be referred to an otolaryngologist, as severe and recurrent middle ear infections can have long-term complications if left untreated. These include scarring of the eardrum with hearing loss, speech and language developmental problems, and meningitis. A hearing test may be needed if you child suffers from frequent ear infections.

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Ear infections are one of the most common diagnoses in sick children in the United States. It is estimated that 75% of all children experience at least one episode of acute otitis media before the age of three years. Learn more about common causes, symptoms and treatment in this slideshow.

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