eMedicine Specialties > Pediatrics: Surgery > Otolaryngology

Otitis Media: Differential Diagnoses & Workup

Author: Muhammad Waseem, MD, Associate Professor of Emergency Medicine in Clinical Pediatrics, Weill Medical College of Cornell University; Consulting Staff, Department of Pediatrics, Bronx Lebanon Hospital; Consulting Staff, Department of Emergency Medicine, Lincoln Medical and Mental Health Center
Coauthor(s): Muhammad Aslam, MD, Instructor in Pediatrics, Harvard Medical School; Chief Clinical Fellow, Department of Newborn Medicine, Children's Hospital Boston; Leslie A Wilson, MD, Chief, Well-Baby Clinic and Chronic Ear Clinic, Department of Pediatrics, Wilford Hall Air Force Medical Center
Contributor Information and Disclosures

Updated: Jul 22, 2008

Differential Diagnoses

Allergic Rhinitis
Mastoiditis
Apert Syndrome
Meningitis, Bacterial
Bacteremia
Nasal Polyps
Cholesteatoma
Nasopharyngeal Cancer
Cleft Lip and Palate
Otitis Externa
Colic
Otosclerosis
Diarrhea
Parainfluenza Virus Infections
Down Syndrome
Passive Smoking and Lung Disease
Fever in the Toddler
Pharyngitis
Fever in the Young Infant
Pneumococcal Infections
Fever Without a Focus
Primary Ciliary Dyskinesia
Gastroenteritis
Respiratory Syncytial Virus Infection
Gastroesophageal Reflux
Rhinovirus Infection
Haemophilus Influenzae Infection
Sinusitis
Head Trauma
Hearing Impairment
Human Immunodeficiency Virus Infection

Workup

Laboratory Studies

  • Laboratory evaluation is usually unnecessary, although many experts recommend a full sepsis workup in infants younger than 12 weeks who present with fever and associated acute otitis media (AOM).
  • OM is associated with multiple systemic diseases and congenital syndromes. AOM may be the first presenting illness in some of these diseases; therefore, order appropriate laboratory studies to confirm or exclude possible systemic or congenital diseases.

Imaging Studies

  • Imaging studies are not indicated in patients with OM unless intratemporal or intracranial complications are suspected.
  • In patients in whom an OM complication is suspected, the imaging study of choice is a contrast-enhanced CT scan of the temporal bones. CT findings help diagnose many complications (eg, mastoiditis, epidural abscess, sigmoid sinus thrombophlebitis, meningitis, brain abscess, subdural abscess). Finely cut CT sections through the temporal bone can reveal ossicular disease and cholesteatoma. MRI is more helpful in depicting fluid collections, especially small middle ear collections. MRI is usually performed following CT if further information is needed for definitive diagnosis.

Other Tests

Procedures

In clinical trials, the criterion standard in the diagnosis of AOM is tympanocentesis to determine the presence of middle ear fluid, followed by culture of the fluid to identify causative pathogens. Because of the expense, effort, and lack of availability, no consensus guidelines call for routine use of tympanocentesis to manage AOM and OME.

  • Tympanocentesis can improve diagnostic accuracy, guide treatment, and help eliminate unnecessary medical or surgical interventions in selected patients with refractory or recurrent middle ear disease.
  • Neonates, infants, and children with AOM who appear severely ill or toxic should undergo early tympanocentesis with culturing. Children with acquired immunodeficiency virus (AIDS) or those who are immunocompromised secondary to steroid therapy, chemotherapy, or immunosuppressive therapy following organ transplantation should undergo early tympanocentesis to exclude unusual organisms or nosocomial infection.
  • A recent report from the Centers for Disease Control and Prevention (CDC) working group on drug-resistant S pneumoniae (DRSP) includes an option for tympanocentesis versus empiric second-line antibiotic therapy in patients in whom initial antibiotic therapy has failed.9

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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Further Reading

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Keywords

otitis media, OM, inflammation of the middle ear, middle ear inflammation, acute otitis media, AOM, otitis media with effusion, OME, serous otitis media, mucoid otitis media, secretory otitis media, glue ear, chronic otitis media, COM, chronic suppurative otitis media, earache, ear infection, middle ear infection, middle ear disease, middle ear effusion, MEE, tympanic membrane, TM, eustachian tube, ET, eustachian tube dysfunction, ETD, tympanocentesis, tympanostomy tube, TT, TT insertion

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Contributor Information and Disclosures

Author

Muhammad Waseem, MD, Associate Professor of Emergency Medicine in Clinical Pediatrics, Weill Medical College of Cornell University; Consulting Staff, Department of Pediatrics, Bronx Lebanon Hospital; Consulting Staff, Department of Emergency Medicine, Lincoln Medical and Mental Health Center
Muhammad Waseem, MD is a member of the following medical societies: American Academy of Pediatrics and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Muhammad Aslam, MD, Instructor in Pediatrics, Harvard Medical School; Chief Clinical Fellow, Department of Newborn Medicine, Children's Hospital Boston
Muhammad Aslam, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Medical Association, Massachusetts Medical Society, and Southern Medical Association
Disclosure: Nothing to disclose.

Leslie A Wilson, MD, Chief, Well-Baby Clinic and Chronic Ear Clinic, Department of Pediatrics, Wilford Hall Air Force Medical Center
Leslie A Wilson, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Orval Brown, MD, Director of Otolaryngology Clinic, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center at Dallas
Orval Brown, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Bronchoesophagological Association, American College of Surgeons, American Medical Association, American Society of Pediatric Otolaryngology, Society for Ear, Nose and Throat Advances in Children, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Alan D Murray, MD, Pediatric Otolaryngologist, ENT for Children; Consulting Staff, Department of Otolaryngology, Medical Center of Lewisville, Children's Medical Center at Dallas, Cook Children's Medical Center; Full-Time Staff, Texas Pediatric Surgery Center, The Pediatric Surgery Center
Alan D Murray, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American College of Surgeons, American Society of Pediatric Otolaryngology, Society for Ear, Nose and Throat Advances in Children, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Maureen Strafford, MD, Arnold P Gold Foundation Associate Professor, Departments of Anesthesiology and Pediatrics, Tufts University and Tufts-New England Medical Center
Maureen Strafford, MD is a member of the following medical societies: American Medical Women's Association, American Pain Society, American Society of Anesthesiologists, International Anesthesia Research Society, Society for Education in Anesthesia, Society for Pediatric Anesthesia, and Society of Cardiovascular Anesthesiologists
Disclosure: Nothing to disclose.

 
 
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