Internal Medicine

0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1120 Otitis Media

OTITIS MEDIA

STEVEN W. CHEUNG, MD

history & physical

Classification

■Acute otitis media (AOM)

■Chronic otitis media (COM)

■Otitis media w/ effusion (OME)

Epidemiology

■2nd most common childhood disease after URI

■13% of children have at least 1 episode of AOM before 3 mo old

■65% of children have at least 1 episode of AOM before1yold

■Increased incidence of AOM in winter; decreased in summer

■Increased incidence of AOM in children whose caretaker smokes

cigarettes

■Decreased incidence of AOM in children who are breast-fed

■Presence of effusion after AOM: 70% at 2 wk, 40% at 4 wk, 10% at

12 wk

History

■Otalgia

■Irritability (in infants)

■Fever

■Hearing loss

■Otorrhea

■Vertigo

■Facial nerve paralysis

Signs & Symptoms

■Tympanic membrane (TM) may be erythematous, bulging, or

retracted

■Pneumatic otoscopy shows decreased mobility, consistent w/ effu-

sion

■In AOM, TM erythematous, inflamed, & hypervascular

■In COM, TM may be perforated & draining fluid

■In otitis externa, movement of pinna elicits discomfort

tests

■Audiogram w/ tympanometry; impedance audiometry for infants