• Infectious: mastoiditis, meningitis, osteomyelitis, intracranial abscess

• Structural: perforated eardrum, cholesteatoma

• Hearing and/or speech impairment Diagnosis4

Certain AOM: Requires all the following:

• Rapid onset of signs and symptoms

• Middle ear effusion findings with pneumatic otoscopy

• Inflammation indicated by either otoscopic evidence (distinct erythema) or otalgia Uncertain AOM: Not all three criteria are present

• Severe AOM: Moderate to severe ear pain or fever of 39°C (102.2°F) or greater

• Nonsevere AOM: Mild ear pain and fever of less than 39°C (102.2°F) in past 24 hours

Other nondrug approaches include the use of external heat or cold to reduce postauricular pain and surgery. Tympanostomy tubes are most useful for patients with recurrent disease or chronic OME with impaired hearing or speech. Adenoidectomy may be necessary for children with chronic nasal obstruction, but tonsillectomy is rarely indicated.

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