Disorders of the Middle Ear Key Points

• Tympanic blistering (bullous myringitis) is simply a variant of acute otitis media (AOM) and should be treated as such.

• The most common infection in children seen in a physician's office is AOM.

• Three criteria are necessary for the diagnosis of AOM: acute onset, middle ear effusion, and signs or symptoms of middle ear inflammation.

• Severe AOM is defined as moderate to severe otalgia and fever greater than 39° C (102.2° F).

• When the diagnosis of AOM is uncertain (<2 criteria), observation is allowed in nonsevere illness.

• Amoxicillin is the drug of choice in treating AOM (80-90 mg/kg/ day in 2 divided doses).

• Influenza vaccine decreases the number of cases of AOM in children 6 to 24 months of age.

• Surgical treatment is necessary for all middle ear and mastoid cholesteatomas.

• Antihistamines, decongestants, antibiotics, and corticosteroids are not recommended for routine use in otitis media with effusion.

• All traumatic perforations of the tympanic membrane require audiologic evaluation to rule out sensorineural hearing loss.

• Sudden sensorineural hearing loss is an otologic emergency.

• Facial weakness in the setting of AOM can require myringotomy with or without tube insertion in addition to broad-spectrum antibiotics.

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