Diagnosis

There is no array of specific symptoms or any particular scoring system that ascertain pediatric OM. An understanding of the associated risk factors and the clinical presentation as described are preludes to decide for further examination. When these are firmly assessed, an examination of the tympanic membrane is then done to make an accurate diagnosis.

1. An Otoscopic evaluation is done to examine the characteristics of the tympanic membrane and it is usually sufficient to confirm OM diagnosis. Blocking cerumen may be removed via curette, gentle suction, or irrigation for better visualization. For pediatric patients, consider the placement of 3% hydrogen peroxide or emulsifying drops, followed by gentle irrigation if curettage is unsuccessful.

2. Tympanometry for objective measure of Middle Ear Function and Middle Ear Effusion

• OM should not be diagnosed in the absence of middle ear effusion
• Measures transfer of acoustic energy as a function of ear canal pressure
• Generates a graph showing how energy admitted to ear canal is reflected back to the internal microphone canal while canal pressure varies from negative to positive
• Flat or nearly flat tracing is indicative of impaired TM vibration due to middle ear fluid which is also a manifestation of OM

Other Diagnostic Testings:

1. Tympanocentesis

• Consider for OM with repeated treatment failure
• Send middle ear fluid specimen for Gram stain, culture, and sensitivity and results will identify presence of causative agents that suggests OM

2. Nasopharyngeal Culture
   • Considered for OM with repeated treatment failure if tympanocentesis is not feasible

When all have been assessed and a positive diagnosis is confirmed, diagnose with mild pediatric OM those with mild otalgia and a temperature of <39◦C (102.2◦F) and diagnose with severe pediatric OM those with moderate-to-severe otalgia or a fever that is ≥39◦C (102.2◦F)