Diagnostic criteria for otitis media in children

Objectives: To determine the accuracy of various symptoms in predicting acute otitis media and the accuracy of pneumo-otoscopy and minitympanometry in identifying middle ear fluid in children. Patients: Symptoms were recorded and compared to pneumo-otoscopic findings in 354 children suffering from acute illness, to analyze the validity of various symptoms in predicting acute otitis media. Pneumo-otoscopic findings were recorded in 76 children and minitympanometric findings in 162 children referred for surgery due to recurrent or chronic otitis media and compared to the myringotomy finding to assess the validity of various pneumo-otoscopic signs and type B minitympanogram in identifying middle ear effusion. Results and Conclusions: The ear-related symptoms were specific, but too unsensitive, and the general symptoms too unsensitive and unspecific to be used alone as criteria for acute otitis media. The abnormal position and impaired mobility of the tympanic membrane in pneumatic otoscopy were very specific signs of middle ear effusion but only the latter had a moderately high sensitivity. When combined by an experienced otoscopist into an overall subjective judgement, however, they afforded an acceptably high sensitivity (81%) and specificity (86%). Type B minitympanogram was reasonably sensitive (79%) and had a high specificity, but only in cooperative children (93%), the specificity in uncooperative children being very low (38%). All in all, penumatic otoscopy and minitympanometry, the latter in cooperative children, are acceptably accurate methods to be used in the diagnosis of both acute otitis media and chronic otitis media with effusion.