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).
Otitis media (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.
When an OM complication is suspected, the imaging study of choice is contrast-enhanced computed tomography (CT) of the temporal bones. CT findings help diagnose many complications (eg, mastoiditis, epidural abscess, sigmoid sinus thrombophlebitis, meningitis, brain abscess, and subdural abscess). Fine-cut CT sections through the temporal bone can reveal ossicular disease and cholesteatoma.
Magnetic resonance imaging (MRI) is more helpful in depicting fluid collections, especially small middle-ear collections. MRI is usually performed after CT if further information is needed for definitive diagnosis.
Tympanocentesis
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 OM with effusion (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 AIDS or those who are immunocompromised secondary to steroid therapy, chemotherapy, or immunosuppressive therapy after organ transplantation should undergo early tympanocentesis to exclude unusual organisms or nosocomial infection.
A report from the Centers for Disease Control and Prevention (CDC) working group on drug-resistant S pneumoniae (DRSP) included an option for tympanocentesis versus empiric second-line antibiotic therapy in patients in whom initial antibiotic therapy has failed. [22]
Other Tests
Tympanometry may help with diagnosis in patients who OME. Some practitioners also use acoustic reflectometry to evaluate for middle ear effusion (MEE) in patients with OM.
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Diagram of the normal tympanic membrane anatomy.
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Healthy tympanic membrane.
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Acute otitis media with purulent effusion behind a bulging tympanic membrane.
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Chronic otitis media with a retraction pocket of the pars flaccida.
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Cholesteatoma of the pars flaccida.
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Central/pars tensa tympanic membrane perforation with a healthy middle ear membrane.
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Central/pars tensa tympanic membrane perforation with a tympanostomy tube in place.
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Various tympanostomy tube styles and sizes.
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Initial presentation of a young girl with chronic right ear pain and multiple untreated middle ear infections.
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Acute coalescent mastoiditis with a Bezold abscess in a young girl who presented with chronic right ear pain and multiple untreated middle ear infections.
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A young girl who presented with chronic right ear pain and multiple untreated middle ear infections on the operating table for mastoidectomy and drainage of Bezold abscess.
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Aspirating pus from the Bezold abscess for Gram staining, culturing, and sensitivity testing in a young girl who presented with chronic right ear pain and multiple untreated middle ear infections.
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Surgical incision to aspirate pus in a young girl who presented with chronic right ear pain and multiple untreated middle ear infections.
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Freer elevator demonstrating extension of an abscess cavity from the mastoid into the neck in a young girl who presented with chronic right ear pain and multiple untreated middle ear infections.
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Incision is closed and a drain is placed in the abscess cavity in a young girl who presented with chronic right ear pain and multiple untreated middle ear infections.
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Postoperative bandage in a young girl who presented with chronic right ear pain and multiple untreated middle ear infections.
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The wound now appears clean and dry on postoperative day 4. This young girl initially presented with chronic right ear pain and multiple untreated middle ear infections.
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Postoperative day 4: Mom is smiling. This young girl initially presented with chronic right ear pain and multiple untreated middle ear infections.
