Diagnosis of acute otitis media
Last reviewed: 23.04.2024
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After finding out the anamnesis and the nature of the general symptoms go to the examination. Special attention is paid to neurological symptoms at this age, they can arise as a result of severe intoxication, the appearance of symptoms of irritation of the meninges (meningism). Meningism is explained by a good vascular connection (blood and lymphatic) between the middle ear and the skull cavity.
Prior to the transition to otoscopy and palpation with external examination pay special attention to the condition of the muscles of facial muscles (paresis of the facial nerve). Protrusion of the ear buds, the expression of the bovine transitional fold, the state of the mastoid process, its temperature, skin color, the presence of edema or infiltration of the skin over it, the increase and soreness of the anterior and posterior lymph nodes, the condition of the sternocleidomastoid muscles, their anterior margin , where the jaw vein passes.
After such a detailed examination, go to the otoscopy. First of all, remember: the examination of the tympanic membrane in infants, and even more so of the newborn, is very complicated because of the narrowness of the external auditory canal and the almost horizontal position of the tympanic membrane. In addition, at this age the external auditory meatus is often filled with epidermal scales, before inserting even the narrowest funnel, they should be carefully removed using a probe with cotton wool soaked in warm mineral oil. As a result, only the upper parts of the tympanic membrane can be inspected, first they are injected, and then become hyperemic. As a rule, other identification marks can not be distinguished. The light reflex appears not earlier than 1.5 months after birth. There are still some circumstances that distort the usual otoscopic picture. For example, only the introduction of the funnel and the toilet of the ear canal themselves cause hyperemia of the tympanic membrane, as is the cry of the child that is accompanied by the examination. The epidermal layer of the tympanic membrane in the newborn and the thoracic child is relatively thickened and not always accompanied by hyperemia even in the inflammatory process in the tympanic cavity. The same applies to the auditory function, it can only be investigated using objective methods. Obligatory diagnostic reception is the determination of the mobility of the tympanic membrane (pneumatic otoscopy).
The blood picture is not specific, acute otitis media is accompanied by leukocytosis with a leftward shift, increased ESR, etc. X-ray examination is usually performed only if there are suspicions of complications.
Decisive for the diagnosis of otitis media - the appearance of pus with perforation of the tympanic membrane or obtaining it with paracentesis (puncture). However, negative data from the paracentesis does not conclusively testify to the absence of an inflammatory process in the tympanum, but they speak only of the fact of the absence of exudate, sometimes it does not have time to form by this time.
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