Diagnosis of otitis media and ear infections

Otitis media is a common illness in young children. Historically it has been associated with frequent and severe complications. These days it is usually a mild condition that often resolves without treatment. This has led us to re-evaluate many interventions that were used routinely in the past. Evidence from a large number of randomised controlled trials can help in discussing treatment options with families. In Australia, Aboriginal children have more severe disease and will benefit from effective treatment of persistent (or recurrent) bacterial infection.

Diagnosis of otitis media

Otitis media is best regarded as a spectrum of disease. The most important conditions are acute otitis media without perforation,
acute otitis media with perforation, otitis media with effusion and chronic suppurative otitis media (see Table 1). There is
currently a lack of consistency in definitions of different forms of otitis media (especially acute otitis media). Children with middle ear infections will usually present with
features related to:

•  pain and/or fever (acute otitis media)
•  hearing loss (otitis media with effusion)
•  ear discharge (acute otitis media with perforation or chronic

suppurative otitis media).
In some children, otitis media will be detected as part of a routine examination. Making an accurate diagnosis is not easy. Generally it requires a good view of the whole tympanic membrane and the use of either pneumatic otoscopy or tympanometry (to confirm the presence of a middle ear effusion). Studies of diagnostic accuracy in acute otitis media have found ear pain to be the most useful symptom, but not
very reliable on its own. Bulging, opacity and immobility of the tympanic membrane are all highly predictive of acute otitis media. Normal (pearly grey) colour of the tympanic membrane makes acute otitis media unlikely