eMedicine Specialties > Emergency Medicine > Ear, Nose, & Throat

Otitis Media: Differential Diagnoses & Workup

Author: Brenda Liz Natal, MD, Clinical Assistant Instructor and Staff Physician, Department of Emergency Medicine, Kings County Hospital and State University of New York Downstate, Brooklyn
Coauthor(s): Jennifer H Chao, MD, FAAP, Clinical Assistant Professor of Pediatric Emergency Medicine, University Hospital of Brooklyn; Attending Physician, Pediatric Emergency Department, Kings County Hospital, Brooklyn
Contributor Information and Disclosures

Updated: Nov 2, 2009

Differential Diagnoses

Bell Palsy
Mastoiditis
Dental pain
Middle Ear, Otitis Media With Effusion
Dysbarism
Otitis Externa
Foreign Bodies, Ear
Pharyngitis
Herpes Zoster Oticus
Sinusitis
Labyrinthitis
Upper Respiratory Tract Infection

Other Problems to Be Considered

Coexistent conjunctivitis
Acute hearing loss
Tympanosclerosis
Erythema caused by crying
Pain referred from the teeth or jaw
Cavernous sinus thrombosis
Cholesteatoma 

Workup

Laboratory Studies

  • No definitive laboratory examination exists for acute otitis media.
  • In the event that a tympanocentesis is performed, a sample of the effusion should be sent for culture and sensitivity.

Imaging Studies

  • Imaging studies are not valuable for diagnosis of acute otitis media.
  • Radiography and/or CT scanning of the mastoid air cells may be helpful in select cases of suspected mastoiditis.

Other Tests

  • Insufflation, tympanometry, and acoustic reflexometry are helpful to identify the presence or absence of middle ear effusion (MEE).
    • Of these, insufflation is the only one commonly used in the ED setting.
    • Tympanometry and acoustic reflexometry cannot be recommended as a routine screening test for acute otitis media. However, in a patient in whom examination is difficult, normal tympanometric results may help rule out acute otitis media.
  • Hearing tests are not helpful in diagnosing acute otitis media.
  • Nasopharyngoscopy may reveal anatomic factors involved in acute otitis media and show purulent matter at the nasal opening of the eustachian tube, but the findings are of no acute diagnostic value.

Procedures

  • Tympanocentesis, myringotomy, or both may be appropriate to delineate the etiology of acute otitis media in an immunocompromised patient, a patient with mastoiditis, a patient with persistent fever in the face of antibiotic therapy, or a patient with intractable pain.
    • If acute otitis media is present in infants younger than 2-3 months, some authors recommend tympanocentesis.
    • These procedures often are performed by the ear, nose, and throat (ENT) consultant.

More on Otitis Media

Overview: Otitis Media
Differential Diagnoses & Workup: Otitis Media
Treatment & Medication: Otitis Media
Follow-up: Otitis Media
Multimedia: Otitis Media
References
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References

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Further Reading

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Keywords

OM, otitis media, ear infection, otitis media symptoms, otitis media causes, otitis media treatment, middle ear inflammation, acute otitis media, AOM, middle ear infection, middle ear effusion, MEE, otitis media with effusion, OME, bulging tympanic membrane, upper respiratory infection, viral infection

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Contributor Information and Disclosures

Author

Brenda Liz Natal, MD, Clinical Assistant Instructor and Staff Physician, Department of Emergency Medicine, Kings County Hospital and State University of New York Downstate, Brooklyn
Brenda Liz Natal, MD is a member of the following medical societies: American College of Emergency Physicians and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Jennifer H Chao, MD, FAAP, Clinical Assistant Professor of Pediatric Emergency Medicine, University Hospital of Brooklyn; Attending Physician, Pediatric Emergency Department, Kings County Hospital, Brooklyn
Jennifer H Chao, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Jerry Balentine, DO, Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St. Barnabas Hospital
Jerry Balentine, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American College of Physician Executives, American Osteopathic Association, and New York Academy of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark W Fourre, MD, Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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