Clinical features

Acute otitis media is more common in children. Its symptoms and signs include:

• symptoms
  • earache, usually throbbing and severe
  • young children unable to express their earache might be noted to frequently rub their ear
  • excessive crying (1)
  • pyrexia up to 40 degrees - child may be flushed
  • otorrhoea will often be blood-stained - profuse and mucoid at first, later becomes thick and yellow
  • mucoid discharge: signifies tympanic membrane perforation, after which pain subsides
• signs
  • conductive deafness is always present, and may be accompanied by tinnitus
  • tympanic membrane signs depend on the stage of infection
    • loss of lustre
    • break-up of the light reflex
    • redness
    • impaired mobility of tympanic membrane (1)
    • fullness of the ear drum - malleus handle becomes more vertical
    • progression to a bulging ear drum - purple colour
    • the final stage is perforation
  • tenderness: possibly to pressure on the mastoid antrum
• diagnostic tests include; (1)
  • acoustic reflectometry
  • pneumatic otoscopy (2)
  • portable tympanometry
  • professional tympanometry

Reference:

• (1) Kalyanakrishnan R et al. Diagnosis and treatment of otitis media.Am Fam Physician 2007;76:1650-8, 1659-60
• (2) Pneumatic otoscopy: virtual classroom of the american academy of paediatrics