Recommendations for clinical care guidelines on the management of Otitis Media in Aboriginal and Torres Strait Islander Populations

Section B: Diagnosis of Otitis Media

Facilitate early detection of persistent otitis media and associated hearing loss to avoid possible adverse effects

Page last updated: 14 October 2011

Facilitate early detection of persistent otitis media and associated hearing loss to avoid possible adverse effects.

StrategyRecommendation and GradingEvidence StudiesEvidence -Based Guidelines
Otitis Media SurveillanceGPP: Ear examination for OM should be part of the clinical assessment of children.

GPP: Health staff should undertake ear examinations when they do regular child health checks. Accurate surveillance of OME usually requires pneumatic otoscopy or tympanometry.
Hearing Loss, Speech and Language SurveillanceGPP: Monitor for hearing loss in all children younger than 5 years and in older children at high risk of hearing impairment. Assessment tools include simplified parental questionnaires, pneumatic otoscopy and tympanometry (in children older than 4 months).IV30I~A16
GPP: Refer for hearing tests if there are parental or teacher concerns about hearing or behaviour or learning. The following milestones are an appropriate indication for immediate referral to a paediatrician and an audiologist:
  • 3-6 mo: not communicating by vocalising or eye gaze
  • 9 mo: poor feeding or oral co-ordination
  • 12 mo: not babbling
  • 20 mo: only pointing or using gestures (i.e. not speaking)
Hearing Loss, Speech and Language Surveillance continued
  • 24 mo: using <20words, not following simple requests
  • 30 mo: no two word combinations.
OtoscopyGrade A: Accurate diagnosis of OM requires assessment of the appearance of tympanic membrane (TM) by otoscope (or video otoscope) plus compliance or mobility of the TM by pneumatic otoscopy or tympanometry.I53,56;89,90;5;28,29,31;91I~A16,18,19
GPP: Otoscopy requires a clear view of the TM. Syringing or cleaning with tissue spears may be required to remove wax, pus or foreign bodies from the ear canal.IV29I~A19
GPP: Cleaning pus from the ear canal with correctly prepared tissues spears can be done by anybody. Syringing with clean warm water can be done by appropriately trained individuals. Cleaning with canal instruments can be done by appropriately trained individuals using direct vision (e.g. a head-light, ‘LumiView’ or operating microscope). Suctioning by a trained health care professional may also help to obtain a clear view of the eardrum.I~A18
GPP: Choose the largest diameter otoscope tip that will fit comfortably in the child’s ear.
Grade A: A bulging, cloudy or distinctly red TM are the most consistent signs in the diagnosis of AOM.I53,56;5;28,25,29I~A15,19
Grade A: Lack of acute inflammation despite visible fluid through an intact TM indicates OME.I53;5,6;25I~A19
GPP: The duration of discharge should be noted. Consideration to be given to documenting the size and position of the TM perforation. This will allow distinction of AOM with perforation from CSOM and the assessment of progression of the disease. AOM with perforation is most common in the first 18 months of life.I~A13
GPP: All episodes of OM managed by the health clinic (and all associated test findings) should be documented in the medical record.I~A16
TympanometryGrade A: In cases where the diagnosis of OME is uncertain, tympanometry can be used as an adjunct to otoscopy.I53;31;92;5;25,30;93-95I~A15-19
GPP: For children at least 4 months of age, tympanometry with a standard 226Hz probe tone is reliable. Infants younger than 4 months may require specialised tympanometric equipment with a higher probe tone frequency.III96,97I~A
Grade A: A type B tympanogram (flat) may be used to confirm a clinical diagnosis of OME.I53;92;25/sup>];30;93,98I~A19
Grade A: A type A or type C tympanogram (peaked) may be used to confirm a clinical diagnosis of no OM. I53;30;25;98
Pneumatic OtoscopyGrade A: Pneumatic otoscopy is the most accurate method of ear examination. It assesses TM mobility. It is recommended for confirming a diagnosis of OME and AOM. I53;5;28;30;25;91,93,94I~A15,18,19
Video OtoscopyGPP: Video otoscopy (if available) should be used. Pneumatic video otoscopy is always the preferred option. Video otoscopy has the following advantages:
  • It provides objective documentation of ear disease and progress over time.
  • It facilitates review of diagnosis by experts at other locations.
  • It helps the families/caregivers to better understand middle ear disease.
III89,90,91, 99,100
Acoustic Reflectometry Grade C: Acoustic reflectometry is another test that may assist in determining the presence of fluid in the middle ear. I31;97;30;101,102I~A15,19
Hearing AssessmentGPP: Neonatal hearing screening aims to detect early, permanent hearing loss. Families and staff should be aware that a ‘Pass’ on a neonatal hearing screen does not guarantee that the child’s hearing will remain adequate for communication development. III103-105,106
GPP: A child can develop (or have deterioration of) sensorineural or conductive hearing loss at any age.IV103,106
GPP: Any child with either bilateral OM (all types) persisting longer than 3 months or suspected hearing loss should be referred to an audiologist for a full hearing assessment.IV5,6;30;25I~A18;13
ENT AssessmentGPP: Any child with OME and hearing loss persisting longer than 3 months should be referred to an ENT specialist.IV25I~A18

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