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Diagnosis of acute otitis media
Last reviewed: 06.07.2025
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After clarifying the anamnesis and the nature of the general symptoms, they proceed to examination. Particular attention at this age is paid to neurological symptoms, they can arise as a result of severe intoxication, the appearance of symptoms of irritation of the meninges (meningism). Meningism is explained by good vascular communication (blood and lymphatic) between the middle ear and the cranial cavity.
Before proceeding to otoscopy and palpation during external examination, special attention is paid to the condition of the facial muscles (facial nerve paresis). The prominence of the auricles, the severity of the postauricular transitional fold, the condition of the mastoid process area, its temperature, skin color, the presence of edema or infiltration of the skin above it, enlargement and soreness of the anterior and posterior auricular lymph nodes, the condition of the sternocleidomastoid muscles, their anterior edge, where the jugular vein passes.
After such a detailed examination, they move on to otoscopy. First of all, it should be remembered: examination of the eardrum in infants, and especially newborns, is very difficult due to the narrowness of the external auditory canal and the almost horizontal position of the eardrum. In addition, at this age, the external auditory canal 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 sections of the eardrum can be examined, at first they are injected and then become hyperemic. Other identification marks, as a rule, cannot be distinguished. The light reflex appears no earlier than 1.5 months after birth. There are still some circumstances that distort the usual otoscopic picture. For example, only the insertion of the funnel and toilet of the ear canal can in themselves cause hyperemia of the eardrum, as can the cry of the child, which accompanies the examination. The epidermal layer of the eardrum in a newborn and infant is relatively thickened and is not always accompanied by hyperemia even with an inflammatory process in the tympanic cavity. The same applies to the auditory function, which can only be examined using objective methods. A mandatory diagnostic measure is determining the mobility of the eardrum (pneumatic otoscopy).
The blood picture is not specific; acute otitis media is accompanied by leukocytosis with a shift to the left, increased ESR, etc. X-ray examination is usually performed only if complications are suspected.
The decisive factor for diagnosing otitis media is the appearance of pus when the eardrum is perforated or obtained by paracentesis (puncture). However, negative paracentesis data do not definitively indicate the absence of an inflammatory process in the tympanic cavity, but only indicate the absence of exudate, sometimes by this time it has not yet had time to form.
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