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Otitis Media, Child: Russell Rothman, MD, discusses the clinical examination for otitis media in children.
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Otitis Media, Child: Russell Rothman, MD, discusses the clinical examination for otitis media in children.
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Upload Date:
2022-02-28T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
>> I'm Joan Stephenson, editor of JAMA's Medical News & Perspectives section. Today this JAMAevidence podcast will focus on a condition that is one of the most commonly diagnosed and expensive childhood illnesses acute otitis media. Our guest expert is Dr. Russell Rothman. Dr. Rothman, why don't you introduce yourself to our listeners. >> Yes. Hi. My name is Russell Rothman, and I am on faculty at Vanderbilt University in both internal medicine and pediatrics.
>> Dr. Rothman, what do we know about the prevalence of acute otitis media in children, and are there important demographic characteristics? >> Acute otitis media is very, very common, accounting for more than 30 million clinic visits a year. By age one, up to 60 percent of all children have been diagnosed with at least one case of acute otitis, and by age three more than 80 percent of children have had at least one episode. And we know that up to one-fifth of office visits for children less than five can be related to acute otitis.
Some studies suggest that acute otitis media is more common among younger children, children less than two, children in daycare, and children with exposure to cigarette smoke. A prior history of otitis also increases one's risk of having otitis again. And finally, there's some data that breastfeeding may be protective against cases of acute otitis. >> Which symptoms, if any, are associated with an increased probability of acute otitis media in children?
>> In our systematic review, we only found a few articles that examine the relationship between symptoms and increased likelihood of acute otitis. All of these articles had some study design flaws, so findings need to be interpreted with caution. In general, we found that ear pain, particularly in children greater than two, may be a helpful symptom. In addition, parental suspicion of acute otitis could be helpful. No other symptoms were consistently correlated with acute otitis.
None of the studies that looked at symptoms were blinded, so it's possible that the providers were led to diagnose or even over-diagnose acute otitis after hearing the symptoms that were brought in at the visit. >> Which history and physical examination findings are helpful when detecting acute otitis media in children, and which findings are not helpful? >> We found one good study looking at physical exam findings. This study found that an ear that has a tympanic membrane that was bulging or cloudy or distinctly immobile on pneumatic otoscopy was highly likely to be associated with acute otitis, with adjusted likelihood ratios in the 30 to 50 range.
Additionally, an ear that was felt to be distinctly red, meaning strongly red, was also found to be somewhat helpful, with an adjusted likelihood ratio over eight. >> I'd like to follow up on your mention of a red tympanic membrane. When the physician sees a red tympanic membrane, couldn't the redness just be the result of the child crying? >> Right. We're typically taught that the tympanic membrane can become red from crying and that red tympanic membranes are not a useful sign in a diagnosis of acute otitis.
While it's true that crying can cause vascular congestion and redness of the membrane, our review also suggests that a membrane that is distinctly red could actually be helpful in the diagnosis of acute otitis. >> Dr. Rothman, are there any reference standard tests for acute otitis media in children? >> Yes. The reference standard test for acute otitis is to perform a tympanocentesis and actually put a needle into the eardrum and remove any fluid from behind the drum to see if there's any evidence of infection.
But this procedure, as you might imagine, is rarely done by primary care providers. >> Is there anything else JAMA Evidence users should know about acute otitis media? >> Our study focused on the evidence related to the diagnosis of acute otitis, and we found that even though acute otitis is a very common problem in children, there's still not a lot of great evidence about how to best diagnose acute otitis. And diagnosis of acute otitis really remains very challenging.
But accurate diagnosis is important to help prevent overtreatment. And in general, I would say one should not diagnose acute otitis media unless a children has presence of a middle ear effusion demonstrated by otoscopy, including the use of pneumatic otoscopy, and also other signs of infection, such as ear pain, fever, or irritability. >> Thank you, Dr. Rothman, for this overview of acute otitis media in children.
And for more information, JAMAevidence subscribers can consult the article by Dr. Rothman and colleagues on this topic. This was originally published in the Rational Clinical Examination. This has been Joan Stephenson of JAMA interviewing Dr. Russell Rothman about acute otitis media in children for JAMAevidence.
