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

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.

02:26 There is a number of possible complications with Otitis media.

02:29 This includes mastoiditis, tympanic membrane perforation, brain abscess and permanent hearing loss.

02:37 There’s a curious finding called bullous myringitis.

02:43 And to describe it to you, it would be a tympanic membrane with a bleb on it, a bulla.

02:53 And when I was in training, I was taught that that was pathognomonic of Mycoplasma pneumoniae ear infection.

03:03 But it turns out that it probably can be caused by any of the common pathogens and it’s not specific to Mycoplasma pneumoniae.

03:16 But the problem is just on the tympanic membrane, there is a bleb on it.

03:23 It presently is just a manifestation of severe acute otitis media, and other bugs can do it.

03:32 So the normal tympanic membrane moves and it moves like a flapping flag, it’s very sensitive to the least movement.

03:45 Well, it has to be for hearing.

03:47 So when it doesn’t move, there’s usually fluid behind it.

03:53 So it’s obvious that the clinical picture is the way we make this diagnosis.

04:02 In most instances, we are not going to be using a needle to get middle ear fluid.

04:11 That was done in days gone by, but we don’t do myringotomies anymore in most patients.

04:21 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.

04:37 In an extremely toxic individual with no response to antibiotics within 48 to 72 hours, we need to find out what’s there.

04:48 And in an immunocompromised patient, they can have funny bugs.

04:53 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.

05:14 So we need to think of strange organisms in immunocompromised patients.