Clinical Manifestations

The onset of AOM in childhood is often associated with fever, lethargy, and irritability. Older children may experience earaches and decreased hearing. Examination with a hand-held otoscope demonstrates tympanic membrane redness, opacity, bulging, and poor mobility when pneumatic pressure is applied. However, there is considerable variability in the symptoms and signs of acute otitis media.

OME is often characterized by hearing loss and a history of recurrent episodes of AOM. Otoscopic findings usually consist of fluid visible behind a retracted tympanic membrane.

CSOM in its active form often presents with foul-smelling drainage and longstanding hearing loss. Otoscopy reveals tympanic membrane retraction, perforation or hyalinization, and often, evidence of bony erosion, with the development of a cystlike mass called cholesteatoma. Development of pain in such an ear is a foreboding sign, as it often represents the obstruction of drainage of the infection, and pus under pressure. Local complications of CSOM include bone erosion producing hearing loss, facial nerve dysfunction, sensorineural hearing loss, ringing sounds in the ear, and vestibular disturbances. On occasion, infection will extend into the bony skull or into the soft tissues of the neck and scalp, either through normal preformed pathways such as vascular channels, or through progressive bone destruction. Catastrophic intracranial complications include abscesses, abnormal fluid accumulation, lateral sinus thrombosis, meningitis, and brain herniation.

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