Verify symptoms and signs
The diagnosis of Acute Otitis Media requires an efficient pediatric ear exam with appropriate visualization of the tympanic membrane.
History
Take a problem-focused history to identify symptoms, parent’s perception, and risk factors. Remember, an effective history aids in the overall clinical picture but no gold standard history markers for the diagnosis of AOM exist.
Approach to pediatric ear exam
It is important to perform the pediatric ear exam in an age and developmental stage appropriate manner. One needs to be able to engage the caregiver in the exam and to inform them regarding the importance of the exam with regards to the diagnosis of AOM. We provide a Standardized Checklist for Otoscopy Performance Evaluation (SCOPE) checklist (full article) regarding the approach to the pediatric exam. We encourage the learner to use this with their patient care encounters in a teaching context. See also this presentation on the pediatric ear exam.
Appearance of the Tympanic Membrane
- One needs to become familiar with the APPROACH to the Pediatric ear exam in order to visualize the tympanic membrane.
- Become familiar with the basic anatomy of the tympanic membrane.
- Practice evaluating the tympanic membrane using the pocket guide – use this pocket guide to make comparisons with your patient’s ear. You can also use other images on the website.
| Normal | Mild erythema only, No effusion, myringitis only |
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| Otitis Media with Effusion Mild erythema, air/fluid level clear fluid, no bulging, retracted TM with prominent short process of the malleolus |
Otitis Media with Effusion Mild erythema, no opacification, retracted TM with prominent short process of the malleolus |
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| AOM vs. OME Uncertainty Mild/moderate bulging, full opacification, air fluid level or air bubble(s), intense erythema |
AOM vs. OME Uncertainty Moderate bulging complete effusion and opacification (no bubbles) intense erythema |
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| Acute Otitis Media Bulging rounded doughnut appearance of tympanic membrane, moderate |
Acute Otitis Media Bulging, bulla, complete effusion, opacification, marked erythema |
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