Classification of Otitis media

Otitis media - Inflammation of the middle ear, with or without signs of fluid or infection.

Acute Otitis Media -"A diagnosis of AOM requires 1) a history of acute onset of signs and symptoms, 2) the presence of middle ear effusion (MEE), and 3) signs and symptoms of middle-ear inflammation." (bulging, hypo-mobile eardrum usually accompanied by pain; or perforated eardrum, often with drainage of purulent material).

The hallmark of acute otitis media (AOM) is decreased mobility of the tympanic membrane (TM) accompanied by a rapid onset of one or more of the following signs & symptoms: otalgia (earache, often evidenced by tugging or rubbing of the ear in children <2 yrs), recent onset of: fever, irritability, anorexia, nausea, vomiting, diarrhea, rhinitis or more rarely, purulent discharge in the ear canal. Otoscopy will reveal an eardrum that is full, bulging and opaque. If the eardrum is intact, pneumatic otoscopy should be used to assess eardrum mobility. Erythema of the eardrum alone is not definitive of OM. graphic is an 18 month old male

Otitis Media with Effusion -"fluid in the middle ear without signs or symptoms of ear infection".

The relatively asymptomatic presence of fluid in the middle ear is characteristic of otitis media with effusion (OME). Otoscopy may reveal a translucent eardrum, but more frequently it is opaque. If the eardrum is translucent, a fluid-air level may be seen. Pneumatic otoscopy is recommended to determine the mobility of the intact eardrum. An immobile eardrum, either retracted or bulging, and the absence of acute symptoms of infection can be indicative of OME. It is theorized that the fluid transudate may develop in two ways. The first is from increased vascular permeability due to inflammation. The second may be due to a negative pressure gradient which can occur when the eustachian tube is obstructed. In either case the fluid is thought to be an accumulation of serum. It is further thought that the viscous nature of some aspirates is due to water re-absorption by the ME membrane.

Chronic Otitis Media - is "OME that is unresponsive to medical management and has persisted for three months bilateral or six months unilateral."

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