Department of Pediatrics
University of Wisconsin School of Medicine and Public Health

Diagnostic Criteria

Diagnostic Criteria of Acute Otitis Media

Please refer to the American Academy of Pediatrics 2013 guidelines which provides evidence for the following diagnostic criteria:

  • Many studies demonstrate the lack of correlation between symptoms and the diagnostic criteria of AOM.
  • The diagnosis of AOM rests on strict diagnostic criteria based on the visualization of the tympanic membrane.
  • Recent research has used precisely stated stringent criteria of AOM for purposes of the studies.
  • The most specific diagnostic criteria of AOM is the bulging of the tympanic membrane according to the 2013 AAP Clinical Practice Guideline February, 2013.  The guidelines include further diagnostic criteria:
    • Moderate to severe bulging of tympanic membrane
    • New onset of otorrhea not new to acute otitis externa
    • Mild bulging ( full) AND recent ( less than 48 hours-acute) onset of ear pain
    • Mild bulging and intense erythema

A, Normal TM. B, TM with mild bulging. C, TM with moderate bulging. D, TM with severe bulging. Courtesy of Alejandro Hoberman, MD.

A, Normal TM. B, TM with mild bulging. C, TM with moderate bulging. D, TM with severe bulging. Courtesy of Alejandro Hoberman, MD.

 

Diagnostic Criteria of Otitis Media with Effusion

Otitis Media with Effusion (OME) is the condition of fluid present in the middle ear. Inflammation may be associated with OME. The spectrum of tympanic membrane findings can be challenging for one to appreciate the subtle differences in the progression from MEE and OME to AOM. Visualization of the tympanic membrane is critical to differentiate between AOM and OME. “A middle ear effusion may be present after resolution of an episode of AOM, or it may develop because of a viral upper respiratory tract infection that produces eustachian tube dysfunction. In both of these settings, the middle ear effusion is not an infectious process and will not benefit from antibiotic therapy.”(https://www.aappublications.org/news/2018/06/26/idsnapshot062618)

 

A, OME with air-fluid levels and bubbles. B, OME with prominent malleus and amber colored fluid. C, OME with prominent malleus and minimal erythema (injection). D, OME with opaque appearance and white colored fluid. Courtesy of ePROM.

A, OME with air-fluid levels and bubbles. B, OME with prominent malleus and amber colored fluid. C, OME with prominent malleus and minimal erythema (injection). D, OME with opaque appearance and white colored fluid. Courtesy of ePROM1.

 

1:Kaleida PH, Ploof DL, Kurs-Lasky M, Shaikh N, Colborn DK, Haralam MA, Ray S, Kearney D, Paradise JL, Hoberman A. Pediatrics. Mastering diagnostic skills: Enhancing Proficiency in Otitis Media, a model for diagnostic skills training. 2009 Oct;124(4):e714-20. doi: 10.1542/peds.2008-2838. Epub 2009 Sep 28.