Acute otitis media diagnosis in childhood: still a problem in 2023?
Francesco Folino1, Marco Caruso1, Pietro Bosi1
1Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Via F. Sforza 35, 20122, Milano, Italy.
Insights
Diagnosing acute otitis media (AOM) in children is challenging. A study found primary care physicians misdiagnosed AOM in 27.6% of cases, often mistaking ear redness for infection without bulging eardrums.
Area of Science:
- Pediatrics
- Otolaryngology
- Infectious Diseases
Background:
- Diagnosing acute otitis media (AOM) in children presents challenges due to non-specific symptoms and difficulties in visualizing the tympanic membrane.
- Accurate AOM diagnosis is crucial for appropriate treatment and preventing complications.
Purpose of the Study:
- To evaluate diagnostic agreement in AOM detection between primary care pediatricians and specialized otoscopy physicians.
- To identify common diagnostic errors in AOM identification.
Main Methods:
- Retrospective analysis of clinical charts for children with recurrent AOM (RAOM).
- AOM diagnosis validation by an experienced physician based on otoscopic findings (bulging eardrum with hyperemia or yellow color).
- Calculation of diagnostic concordance percentage between primary care/ER pediatricians and the validator.
Main Results:
- Analysis included 134 AOM episodes in 87 children.
- Diagnostic concordance was 72.4% between primary care/ER pediatricians and the validator.
- The primary diagnostic pitfall was misidentifying tympanic membrane hyperemia without bulging as AOM (32/37 non-validated diagnoses).
Conclusions:
- Acute otitis media diagnosis remains a significant challenge for pediatricians.
- Tympanic membrane hyperemia without bulging is a common factor leading to diagnostic confusion and potential misdiagnosis.
Background:
Diagnosis of acute otitis media (AOM) in children can be challenging, given that symptoms are often non-specific or absent, and that the direct observation of the tympanic membrane in its entirety through otoscopy can sometimes be difficult. The aim of this study is to assess the diagnostic concordance in detection of AOM episodes between primary care paediatricians and physicians especially trained in paediatric otoscopy, and to characterize the most misleading elements in diagnostic failure.
Methods:
Consecutive clinical charts of children regularly followed for recurrent AOM (RAOM, i.e.: >3 episodes in 6 months or > 4 episodes in 1 year) at our Otitis Media paediatric outpatient clinic were retrospectively screened, in order to collect any diagnosis of AOM episode (and the related clinical findings/middle ear complaints) performed by primary care paediatricians/emergency room paediatricians. Diagnosis of AOM episode was validated by the same experienced physician (FF) in case of otoscopic relief of a bulging eardrum with at least one of the following: hyperaemia or yellow-like colour. The diagnostic concordance in detection of AOM episodes between primary care/emergency room paediatricians and our internal validator was expressed as the percentage of matching diagnosis.
Results:
One hundred and thirty-four single AOM episodes occurring in 87 children (mean age: 26.9 +/- 18.9 months) were included in the analysis. Diagnostic concordance in detection of AOM episodes between primary care/emergency room paediatricians and our internal validator was reported in 72.4% of cases. The most common pitfall found in our study was the misleading diagnosis of AOM in case of hyperaemic tympanic membrane without bulging (32/37 out of non-validated diagnoses).
Conclusions:
AOM diagnosis still represents a relevant issue among paediatricians in our country, and the presence of tympanic membrane hyperaemia without concomitant bulging can be confusing.
Related Concept Videos
01:30Pneumonia III: Complications and Assessment
01:30Acute Pharyngitis
Acute pharyngitis is the inflammation of the back of the throat (pharynx), commonly resulting in a sore throat. It is a frequently encountered condition that prompts individuals to seek medical advice.
Classification
Acute pharyngitis can be categorized based on its underlying cause:
01:30Tonsillitis I: Introduction
Etiology
Three primary contributing factors have been identified.
01:30Attention-Deficit/Hyperactivity Disorder
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings....
01:26Tonsillitis II: Management
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include: