Diagnosis of Otitis Media Related to Treatment

Important in the decision to treat or not treat otitis media, the clinician must appreciate the diagnostic differences between acute otitis media and otitis media with effusion, as the latter condition is usually not treated unless it becomes chronic (Table 78-1).

Acute otitis media is characterized by the rapid, brief onset of signs and symptoms of infection in the middle ear. One or more of the following are present: otalgia (or pulling of the ear in the infant), fever, or irritability of recent onset. The tympanic

* Maria B. Bluestone provided editorial assistance in the preparation of this manuscript.

membrane is full or bulging, opaque, and has limited or no mobility to pneumatic otoscopy. After an episode of acute otitis media, the middle ear may have fluid that remains for weeks to months, which has been termed persistent middle ear effusion.

Otitis media with effusion is a relatively asymptomatic middle ear effusion. Pneumatic otoscopy frequently shows either a retracted or concave tympanic membrane, the mobility of which is limited or absent. However, fullness, or even bulging, may be visualized. In addition, an air-fluid level or bubbles, or both, may be observed through a translucent tympanic membrane.

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