eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Middle Ear & Mastoid

Middle Ear, Acute Otitis Media, Medical Treatment: Differential Diagnoses & Workup

Author: John D Donaldson, MD, FRCS(C), FAAP, FACS, Chairman, Board of Directors, Lee Memorial Health System; President-elect, Florida Pediatric Society
Contributor Information and Disclosures

Updated: Sep 28, 2009

Differential Diagnoses

External Ear, Infections

Other Problems to Be Considered

External otitis
Dental pain
Temporomandibular joint pain
Acute viral pharyngitis
Trauma to the ear

Workup

Laboratory Studies

Culture and sensitivity of a specimen from a fresh perforation or a tympanocentesis may be helpful.

Imaging Studies

CT scanning may be necessary to determine if a complication has occurred; otherwise, imaging studies are unnecessary. MRI might be more appropriate to diagnose suspected intracranial complications.

Other Tests

  • Audiometry
    • All children with AOM have conductive hearing loss associated with the middle ear effusion; consequently, testing in the acute phase is probably unhelpful.
    • Tympanometry may assist in the diagnosis of middle ear effusion but, for the skilled pneumatic otoscopist, is seldom necessary.

Procedures

  • Perform tympanocentesis in the following patients:
    • Neonates younger than 6 weeks with AOM
    • Patients who are immunocompromised
    • Patients in whom adequate antimicrobial treatment has failed
    • Patients with a complication that requires a culture for adequate therapy

More on Middle Ear, Acute Otitis Media, Medical Treatment

Overview: Middle Ear, Acute Otitis Media, Medical Treatment
Differential Diagnoses & Workup: Middle Ear, Acute Otitis Media, Medical Treatment
Treatment & Medication: Middle Ear, Acute Otitis Media, Medical Treatment
Follow-up: Middle Ear, Acute Otitis Media, Medical Treatment
Multimedia: Middle Ear, Acute Otitis Media, Medical Treatment
References
Further Reading
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Further Reading

Clinical guidelines
Cincinnati Children's Hospital Medical Center. Evidence based clinical practice guideline for medical management of acute otitis media in children 2 months to 13 years of age. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2004 Oct. 16 p.

University of Michigan Health System (UMHS). Otitis media. Ann Arbor (MI): University of Michigan Health System (UMHS); 2007 July. 12 p.

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Keywords

acute otitis media, AOM, OM, acute suppurative otitis media, acute otitis, otitis media with effusion, OME, chronic otitis media, COM, ear infection, ear ache, eustachian tube destruction, upper respiratory infection, URI, upper respiratory tract infection, URTI, bacterial ear infection, viral ear infection, Streptococcus pneumoniae, S pneumoniae, Haemophilus influenzae, H influenzae, Moraxella catarrhalis, M catarrhalis, Streptococcus pyogenes, S pyogenes, Staphylococcus aureus, S aureus, Streptococcus viridans, S viridans, Pseudomonas aeruginosa, P aeruginosa, staph infection, strep infection, otorrhea, ear bacteremia, middle ear effusion, otalgia, ear tugging, tympanocentesis, myringotomy

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Contributor Information and Disclosures

Author

John D Donaldson, MD, FRCS(C), FAAP, FACS, Chairman, Board of Directors, Lee Memorial Health System; President-elect, Florida Pediatric Society
John D Donaldson, MD, FRCS(C), FAAP, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American College of Surgeons, and American Society of Pediatric Otolaryngology
Disclosure: Nothing to disclose.

Medical Editor

Carol A Bauer, MD, FACS, Associate Professor of Surgery, Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine
Carol A Bauer, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Neurological Association, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Gregory C Allen, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Gregory C Allen, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Christian Medical & Dental Society, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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