Otoscopy for the diagnosis of otitis media

• Published in: The Pediatric infectious disease journal Vol. 17; no. 6; pp. 540 - 543
• Main Author: PELTON, STEPHEN I
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Baltimore, MD Williams & Wilkins 01-06-1998; Philadelphia, PA Lippincott; Hagerstown, MD
• Subjects: Acute Disease; Bacterial diseases; Biological and medical sciences; Child; Child, Preschool; Ent and stomatologic bacterial diseases; Human bacterial diseases; Humans; Infant; Infectious diseases; Medical sciences; Otitis Media - diagnosis; Otoscopes; Pediatrics - education; Sensitivity and Specificity; Human; Otoscopy; Effusion; Middle ear disease; Acute; ENT disease; Otitis media; Diagnosis; Child
• ISSN: 0891-3668; 1532-0987
• DOI: 10.1097/00006454-199806000-00032

The diagnosis of acute otitis media (AOM) is neither easy nor straightforward. Signs and symptoms of upper respiratory illness overlap with AOM. Fever, irritability and sleep disruption can be found frequently in children with both conditions. Even earache, which is the most reliable symptom for differentiating children with otitis media from those with upper respiratory illness, is limited in value in children <2 years old. A bulging tympanic membrane (TM) or perforation with otorrhea were the signs reported to provide diagnostic certainty of AOM among general practitioners in 10 countries. Other signs, such as erythema, were subjective and associated with lower levels of diagnostic certainty. Middle ear disease is the most frequent diagnosis made by health care professionals caring for children and has been associated with widespread use of antibiotics. Experts at the CDC have admonished physicians to use antibiotics more judiciously. A debate about restricting antimicrobial therapy in children with AOM as one strategy to decrease antimicrobial usage is ongoing. An alternative or adjunctive strategy would be to improve the sensitivity and specificity of clinicians' diagnosis of AOM. This paper critiques the value of pneumatic otoscopy and proposes incorporating a formal curriculum for pneumatic otoscopy into pediatric training.