Acute Otitis Media Workup

Updated: Dec 27, 2021
  • Author: John D Donaldson, MD, FRCSC, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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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.



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


Laboratory Studies

A study by Pichichero and Almudevar indicated that the presence of AOM caused by nontypeable H influenzae, as well as the disease’s cure, can be determined from serum levels of S100A12 protein and interleukin-10 (IL-10). [21]