The Rational Clinical Examination
David L. Simel, Drummond Rennie
Otitis Media, Child
Russell Rothman, Thomas Owens, David L. Simel
Other techniques used in the diagnosis of AOM include tympanocentesis, tympanometry, and acoustic...
Topics Discussed:
diagnostic process, otitis, otitis media, otitis media, acute, pediatric discipline, tympanic membrane, tympanostomy
Excerpt:
"Acute otitis media can be a difficult and controversial diagnosis
to make, but studies suggest that AOM is responsible for more than
30 million clinic visits a year in the United States, at a total cost
exceeding $5 billion. This makes AOM one of the most commonly
diagnosed and expensive childhood illnesses.1-4 Studies
have shown that by age 1 year, up to 60% of all children
have been diagnosed as having at least 1 episode of AOM, and by
age 3 years, more than 80% of children have had at least
1 episode.1,5 The best estimates of the prevalence
of AOM are based on the National Ambulatory Medical Care Survey.
In 1990, the percentage of office visits with otitis media as the
principal diagnosis was 17.4% for children aged 0 to 2
years, 18.1% for children aged 2 to 5 years, 10.5% for
children aged 6 to 10 years, and 5.2% for children aged
11 to 15 years.6 The most common potential risk
factors for diagnosis of AOM include age younger than 2 years, male sex,
day care attendance, fall or winter season, exposure to cigarette
smoke, genetic factors, and history of AOM.1,7 Breastfeeding
appears to be protective.7Genetic, infectious, immunologic, and environmental factors contribute
to an underlying predisposition to ear infections.2 The
eustachian tube, shorter and angled much less steeply in children than
in adults, plays a critical role by more easily allowing the reflux
of organisms from the nasopharynx into the middle ear.2 When
the tube becomes congested, as it may with a viral infection in
the upper respiratory tract, negative pressure within the middle
ear causes secretions to accumulate, and this leads to the proliferation
of pathogenic organisms. The bacterial agents most commonly identified
in AOM include Streptococcus pneumoniae, Haemophilus
influenzae, and Moraxella catarrhalis.5 Coinfection
with viruses is also observed in 30% to 40% of
cases and may play a role in the virulence of symptoms, but less than
10% of AOM is caused by viruses alone.5,14,15 Most
ear infections resolve without any specific treatment, so the exact
role of bacterial or viral pathogens remains unclear...."
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