Department of Pediatrics
University of Wisconsin School of Medicine and Public Health

Problem-Focused History

Taking a Problem-Focused History Specific to Acute Otitis Media

Symptoms

Allow the caregiver to provide their own history of the child’s illness. A brief open-ended question, such as “Tell me about your child’s problem,” is usually sufficient to start the conversation. Diagnosis with acute otitis media is solely dependent on visualization of the tympanic membrane and meeting diagnostic criteria. Still, key questions regarding symptoms such as pain (the most sensitive presenting symptoms) are helpful to the overall pediatric ear exam. Pain manifests itself in different symptoms depending on the age and development of the child. Typical questions regarding acute pain, fussiness, disruption in feeding and disruption in sleep are helpful questions for the relevant History of Presenting Illness (HPI).

Other Symptoms that can be Pertinent to the Diagnosis of AOM Questions

In addition, it is helpful to know whether the child has had prior ear surgery, and if there are any risk factors that may predispose to ear infection. Important risk factors are covered by the following questions:

  1. Was the child breast fed?
  2. Does the child attend day care?
  3. How large is the day-care group? How many hours per week?
  4. Is the child exposed to tobacco smoke?
  5. How many prior ear infections has the child experienced?
  6. How old was the child when his/her ear infections occurred?
  7. Has the child ever had ear tubes or surgery on his ears?
  8. Has the child recently been taking antibiotics? Is the child allergic to antibiotics?
  9. Has the child generally been healthy, or is there an underlying medical condition?
  10. Has the child received pneumococcal and influenza virus vaccine?

Parent Perception of Illness

A simple analog scale marked by the parent/guardian can correlate with the parent’s perception of the severity of the child’s illness.

Which face describes your child's symptoms during the past 24 hours?

 

Pocket Guide

Click here to download a pocket guide. One side is this Symptom Severity analog scale; the back side is the Tympanic Membrane severity grading scale referred to in another section of this module.