Acute Otitis Media Workup

  • Author: John D Donaldson, MD, FRCS(C), FAAP, FACS; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Dec 6, 2011
 

Approach Considerations

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

Computed tomography (CT) may be necessary to determine if a complication has occurred; otherwise, imaging studies are unnecessary. Magnetic resonance imaging (MRI) might be more appropriate for diagnosing suspected intracranial complications. All children with acute otitis media (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.

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Tympanocentesis

Tympanocentesis involves aspiration of the contents of the middle ear cleft by piercing the tympanic membrane with a needle and collecting that material for diagnostic examination. Normally, the hole is small enough to permit healing within 1 or 2 days.

Tympanocentesis should be performed in the following AOM patients:

  • Neonates who are younger than 6 weeks (and therefore are more likely to have an unusual or more invasive pathogen)
  • Patients who are immunosuppressed or immunocompromised
  • Patients in whom adequate antimicrobial treatment has failed and who continue to show signs of local or systemic sepsis
  • Patients who have a complication that requires a culture for adequate therapy
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Contributor Information and Disclosures
Author

John D Donaldson, MD, FRCS(C), FAAP, FACS  Pediatric Otolaryngologist, Lee Memorial Health System

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.

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 Unrestricted 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; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

Additional Contributors

John C Li, MD Private Practice in Otology and Neurotology; Medical Director, Balance Center

John C Li, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Tinnitus Association, Florida Medical Association, and North American Skull Base Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

References

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  2. Bernstein JM. The role of IgE-mediated hypersensitivity in the development of otitis media with effusion. Otolaryngol Clin North Am. Feb 1992;25(1):197-211. [Medline].

  3. American Academy of Pediatrics. Respiratory syncytial virus. In: Red Book: Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, Ill: 2006:560-566.

  4. Arola M, Ruuskanen O, Ziegler T, et al. Clinical role of respiratory virus infection in acute otitis media. Pediatrics. Dec 1990;86(6):848-55. [Medline].

  5. Arola M, Ziegler T, Ruuskanen O. Respiratory virus infection as a cause of prolonged symptoms in acute otitis media. J Pediatr. May 1990;116(5):697-701. [Medline].

  6. Block SL. Causative pathogens, antibiotic resistance and therapeutic considerations in acute otitis media. Pediatr Infect Dis J. Apr 1997;16(4):449-56. [Medline].

  7. American Academy of Pediatrics. Pneumococcal infections. In: Red Book: Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, Ill: 2006:525-537.

  8. American Academy of Pediatrics. Haemophilus influenzae infections. In: Red Book: Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, Ill: 2006:310-3318.

  9. American Academy of Pediatrics. Group A streptococcal infections. In: Red Book: Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, Ill: 2006:610-620.

  10. Paradise JL, Rockette HE, Colborn DK, et al. Otitis media in 2253 Pittsburgh-area infants: prevalence and risk factors during the first two years of life. Pediatrics. Mar 1997;99(3):318-33. [Medline].

  11. Fireman B, Black SB, Shinefield HR, et al. Impact of the pneumococcal conjugate vaccine on otitis media. Pediatr Infect Dis J. Jan 2003;22(1):10-6. [Medline].

  12. Hong W, Peng D, Rivera M, Gu XX. Protection against nontypeable. National Institutes of Health. Haemophilus influenzae. challenges by mucosal vaccination with a detoxified lipooligosaccharide conjugate in two chinchilla models. Microbes Infect. 2010 Jan;12(1):11-8..

  13. Azarpazhooh A, Limeback H, Lawrence HP, Shah PS. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database Syst Rev. Nov 9 2011;11:CD007095. [Medline].

 
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Healthy tympanic membrane.
Tympanic membrane of a person with 12 hours of ear pain, slight tympanic membrane bulge, and slight meniscus of purulent effusion at bottom of tympanic membrane. Reproduced with permission from Isaacson G: The natural history of a treated episode of acute otitis media. Pediatrics. 1996; 98(5): 968-7.
Drawing of normal right tympanic membrane. Note outward curvature of pars tensa (*) of eardrum. Tympanic annulus is indicated anteriorly (a), inferiorly (i), and posteriorly (P). M = long process of malleus; I = incus; L = lateral (short) process of malleus.
 
 
 
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