History and exam

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Cliquez ici pour les guides de pratique clinique sur l'otite moyenne aiguë et leur mise en œuvre dans le contexte belgePublished by: ebpracticenet adminLast published: 2024Acute otitis media (NL versie)Published by: ebpracticenet adminLast published: 2024

Key diagnostic factors

common

otalgia

Otalgia is a nonspecific symptom that is required for the diagnosis of AOM in older children and adults.[19][26]

preceding upper respiratory symptoms

Upper respiratory infection symptoms may be ongoing or resolving and are nonspecific.

bulging tympanic membrane

A purulent middle ear effusion and a tympanic membrane with a loss of landmarks, splayed or attenuated light reflex, and characteristic bagel or doughnut appearance (evidence of positive pressure) is pathognomonic.[19][Figure caption and citation for the preceding image starts]: Otoscopy appearance of a bulging, erythematous tympanic membrane and absent landmarksFrom the personal collection of Dr Armengol [Citation ends].com.bmj.content.model.Caption@7126b322[Figure caption and citation for the preceding image starts]: Purulent middle ear effusion and tympanic membrane with a loss of landmarks and characteristic bagel or doughnut appearanceFrom the personal collection of Dr Armengol [Citation ends].com.bmj.content.model.Caption@71e4ea24

myringitis

Erythema of the tympanic membrane is nonspecific and may be present with crying, fever, and other otologic conditions such as otitis media with effusion, otitis externa, and tympanic membrane retraction. [Figure caption and citation for the preceding image starts]: Otoscopy of myringitis, showing erythema and injection of the tympanic membrane in the neutral positionFrom the personal collection of Dr Armengol [Citation ends].com.bmj.content.model.Caption@15778ebf

Other diagnostic factors

common

irritability

Irritability is a nonspecific symptom common in younger children. Younger patients may cry inconsolably.

sleep disturbance

Restless sleep is a nonspecific symptom.

fever

Fever is a nonspecific sign.

uncommon

decreased appetite

Decreased appetite is a nonspecific symptom.

Risk factors

strong

day care attendance

Observational studies have linked day care attendance to the development of AOM.[2][4][13]​​ This risk factor may increase a child's exposure to respiratory viruses. It is not clear whether modifying this risk factor would decrease the risk of developing the condition.

older siblings

Observational studies have linked the presence of older siblings to the development of AOM.[1][2][4][9][13]​​[14][15]​ This risk factor may increase a child's exposure to respiratory viruses.

young age

Observational studies have linked this nonmodifiable risk factor to the development of the condition.[1][4][16]

family history

Observational studies have linked this nonmodifiable risk factor to the development of the condition.

Native American or Native Alaskan

Observational studies have linked this nonmodifiable risk factor to the development of the condition.[17]

absence of breastfeeding

Observational studies have linked this risk factor to the development of AOM.[1][2][4][13]​​ Breastfeeding reduced the odds of AOM in a prospective cohort study.[15]

supine feedings (bottle propping)

Observational studies have linked supine feeding to the development of AOM.[1] It is not clear whether modifying this risk factor would decrease the risk of developing the condition.

lower socioeconomic status

Observational studies have linked this risk factor to the development of AOM.[2][13] It is not clear whether modifying this risk factor would decrease the risk of developing the condition.

craniofacial anomaly

Children with anatomic anomalies (e.g., cleft palate, cleft uvula) encounter more AOM than their peers.

immunologic deficiency

Children with immunologic deficiencies encounter more AOM than their peers.

weak

male sex

Observational studies have linked this nonmodifiable risk factor to the development of the condition.[1][2][13][15]

pacifier use

Observational studies have linked pacifier use to the development of AOM.[18] It is not clear whether modifying this risk factor would decrease the risk of developing the condition.

environmental tobacco smoke

Observational studies have linked tobacco smoke exposure to the development of AOM.[1][2][4] It is not clear whether modifying this risk factor would decrease the risk of developing the condition.

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