Lectures

Acute Otitis Media (Middle Ear Infection): Signs and Symptoms

by John Fisher, MD
(1)

Questions about the lecture
My Notes
  • Required.
Save Cancel
    Learning Material 2
    • PDF
      Slides OtitisMedia InfectiousDiseases.pdf
    • PDF
      Download Lecture Overview
    Report mistake
    Transcript

    00:01 So an acute otitis media is a challenge for all physicians, especially pediatricians because the children may not be able to tell you that they have ear pain.

    00:16 So ear pain and hearing loss, at least transient hearing loss, are fairly common in acute otitis media.

    00:28 This is part of the challenge of identifying babies who have acute otitis media, sometimes it’s very difficult to examine them.

    00:37 You definitely need a good assistant to hold the patient still.

    00:45 There’s always the danger of injuring their external auditory canal with the otoscope.

    00:52 A wiggling, screaming child is difficult to evaluate and the pediatricians are notorious for being very patient and it’s a very wonderful calling.

    01:08 But what they’re looking for is marked tympanic membrane erythema and the eardrum can look red when a child is having forceful Valsalva maneuvers such as when they’re crying.

    01:26 They’re also looking for a bulge in the tympanic membrane where it seems to be coming toward the observer.

    01:36 That’s difficult to see.

    01:39 Also, difficult to see is impaired mobility of the tympanic membrane, you really need a cooperative patient to do that.

    01:48 And normally, the eardrum is supposed to be very mobile.

    01:55 If it’s not mobile, there’s probably fluid behind it.

    02:02 Some of the nonspecific clinical features that pediatricians think about are ear pulling, irritability, fever, decreased appetite, and sleep disturbance.

    02:15 So I think you can see why a lot of kids get antibiotics because the physician just can’t be sure whether they have otitis media or not.

    02:27 There’s a curious finding called bullous myringitis.

    02:33 And to describe it to you, it would be a tympanic membrane with a bleb on it, a bulla.

    02:42 And when I was in training, I was taught that that was pathognomonic of Mycoplasma pneumoniae ear infection.

    02:53 But it turns out that it probably can be caused by any of the common pathogens and it’s not specific to Mycoplasma pneumoniae.

    03:06 But the problem is just on the tympanic membrane, there is a bleb on it.

    03:13 It presently is just a manifestation of severe acute otitis media, and other bugs can do it.

    03:23 So the normal tympanic membrane moves and it moves like a flapping flag, it’s very sensitive to the least movement.

    03:34 Well, it has to be for hearing.

    03:37 So when it doesn’t move, there’s usually fluid behind it.

    03:44 So it’s obvious that the clinical picture is the way we make this diagnosis.

    03:52 In most instances, we are not going to be using a needle to get middle ear fluid.

    04:00 That was done in days gone by, but we don’t do myringotomies anymore in most patients.

    04:10 You would do a myringotomy and get some middle ear fluid, your ENT physician would generally do that, in somebody who had otitis media and was critically ill, and I think you can see why we would need to know what bug is making the patient critically ill.

    04:27 In an extremely toxic individual with no response to antibiotics within 48 to 72 hours, we need to find out what’s there.

    04:38 And in an immunocompromised patient, they can have funny bugs.

    04:43 And I know of a patient that had actually tuberculous otitis media that was missed and missed and missed again until finally, one of the ENT physicians did a biopsy of some tissue around the middle ear and was able to make the diagnosis.

    05:03 So we need to think of strange organisms in immunocompromised patients.


    About the Lecture

    The lecture Acute Otitis Media (Middle Ear Infection): Signs and Symptoms by John Fisher, MD is from the course Upper Respiratory Infections. It contains the following chapters:

    • Acute Otitis Media – Signs/Symptoms
    • Acute Otitis Media – Diagnosis

    Included Quiz Questions

    1. That the patient has severe acute otitis media.
    2. That the patient must have myringotomy and tube placement.
    3. That the infectious agent is a mycoplasma species.
    4. That the infectoius agent is typically a virus and no antibiotics are neccessary.
    5. That the disease is mild and will self resolve.
    1. A 4 year old on chemotherapeutic agents for leukemiat.
    2. An infant less than 6 months old.
    3. A 4 year old with a second bout of otitis media within one year.
    4. Any patient with bullous myringitis.
    5. Young children with non-specific symptoms of an ear infection and uncertain diagnosis.
    1. Crying
    2. Intracranial bleed due to the fall.
    3. Injury to the mastoid process due to the fall.
    4. The child must have bilateral acute otitis media, causing him to get dizzy and fall in the first place.
    5. A viral upper respiratory infection.
    1. Rash
    2. Ear pulling
    3. Irritability
    4. Sleep disturbance
    5. Decreased appetite

    Author of lecture Acute Otitis Media (Middle Ear Infection): Signs and Symptoms

     John Fisher, MD

    John Fisher, MD


    Customer reviews

    (1)
    5,0 of 5 stars
    5 Stars
    5
    4 Stars
    0
    3 Stars
    0
    2 Stars
    0
    1  Star
    0