Classification of Otitis media

Otitis media is a general term which indicates inflammation within the middle ear. The generality of the term "otitis media" has often impeded scientific research and the comparison of clinical findings because of ambiguity of terminology . To facilitate clinical investigation and reduce confusion, the Agency for Health Care Policy and Research (AHCPR) suggests using the following terms and definitions when diagnosing, assessing and treating otitis media.

Otitis media - "Inflammation of the middle ear, with or without signs of fluid or infection."

Acute Otitis Media -"fluid in the middle ear accompanied by signs or symptoms of ear infection (bulging eardrum usually accompanied by pain; or perforated eardrum, often with drainage of purulent material)".

The hallmark of acute otitis media (AOM) is the recent onset of a middle ear infection manifesting one or more of the following signs or symptoms: otalgia (tugging or rubbing of the ear in children <2yrs), fever, irritability, anorexia, nausea, vomiting ,diarrhea, rhinitis or more rarely, purulent discharge in the ear canal accompanied by decreased mobility of the tympanic membrane (TM). Otoscopy will reveal an eardrum that is full, bulging and opaque. If the eardrum is intact, pneumatic otoscopy should be used to assess eardrum mobility. Erythema of the eardrum alone is not a definitive finding for AOM. AOM usually follows shortly after the onset of an upper respiratory infection.

graphic is an 18 month old male

Otitis Media with Effusion -"fluid in the middle ear without signs or symptoms of ear infection".

The relatively asymptomatic presence of fluid in the middle ear is characteristic of otitis media with effusion (OME). Otoscopy may reveal a translucent eardrum, but more frequently it is opaque. If the eardrum is translucent, a fluid-air level may be seen. Pneumatic otoscopy is recommended to determine the mobility of the intact eardrum. An immobile eardrum, either retracted or bulging, and the absence of acute symptoms of infection can be indicative of OME.

It is theorized that the fluid transudate may develop in two ways. The first is from increased vascular permeability due to inflammation. The second may be due to a negative pressure gradient which can occur when the eustachian tube is obstructed.

In either case the fluid is thought to be an accumulation of serum. It is further thought that the viscous nature of some aspirates is due to water re-absorption by the ME membrane.

Recurrent Otitis Media (ROM) - is defined as ">3 AOM in six months or >4 AOM in 1 year." Children at risk for ROM may be candidates for prophylactic antibiotic and/or surgical management. Characteristics that increase a child's risk for ROM include:

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A 3 y/o boy presents with earache. You suspect AOM. Select the symptoms that support your diagnosis.
Inflammed immobile TM, earache, hearing loss
Earache, fever, hearing loss, immobile TM

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