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Make the Diagnosis: Otitis Media, Child

Prior Probability

The prevalence of clinically diagnosed otitis media is high, with a rate of 17.4% for all visits to US pediatricians for 0- to 24-month-old children, 18% for 2- to 5-year-old children, 10% for 6- to 10-year-old children, and 5.2% for 11- to 15-year-old children. A baseline prevalence of 20% is a reasonable anchor for child visits to the emergency department.

Population for Whom Acute Otitis Media Should Be Considered

The diagnosis should be considered for a child complaining of ear symptoms. Among infants, the rapid onset of ear pulling, ear drainage, irritability, or fever should prompt an otoscopic evaluation for otitis media.

Detecting the Likelihood of Acute Otitis Media

Healthy children who cry before and during the examination are unlikely to have distinctly red tympanic membranes. Therefore, discovering red tympanic membranes should not be attributed solely to crying. The most useful findings are tympanic membrane color, mobility, and position (Table 37-5).

Table 37-5Detecting the Likelihood of Acute Otitis Media

Reference Standard Tests

Tympanocentesis is the reference standard, but most studies use a standardized clinical definition.

Original Article: Does This Child Have Acute Otitis Media?

Clinical Scenario

A mother notices that her 15-month-old child has a low-grade fever and is tugging at his ears after several days of cough and runny nose. The child attends day care services and had 1 previous episode of acute otitis media (AOM) about 4 months ago. In the physician's office, he is afebrile but somewhat irritable and has clear rhinorrhea, mild posterior pharyngeal erythema, and normal chest auscultatory findings. Cerumen occludes the view of his right tympanic membrane, whereas the left tympanic membrane shows normal landmarks and good mobility on pneumatic otoscopy. After removal of the cerumen from his right ear, landmarks are visible on a slightly erythematous tympanic membrane. The tympanic membrane shows normal mobility on pneumatic otoscopy.

Why Is This an Important Question to Answer With the Clinical Examination?


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