September 01, 2011
1 min read

Bulging tympanic membrane a sign of AOM

Kalu SU. Pediatr Infect Dis J. 2011;30:95-99.

Shaikh N. Pediatr Infect Dis J. 2011;doi:10.1097/INF.0b013e31822e6637.

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A group of researchers, including Infectious Diseases in Children Editorial Board member Alejandro Hoberman, MD, are advocating that a bulging tympanic membrane be used as a diagnostic requirement before treating a child for acute otitis media during a clinical trial with antimicrobials.

Hoberman and other researchers looked at data from 783 children who had been examined by “experienced otoscopists.” The researchers also looked at endoscopic images of the children’s tympanic membranes. Seven independent physicians, whom the researchers said were also very skilled at otoscopy, then looked at several of the endoscopic images. The researchers compared both groups of observers to determine what their diagnosis was, either AOM, otitis media with effusion (OME), and no effusion.

Alejandro Hoberman
Alejandro Hoberman

The researchers said bulging of the tympanic membrane was the most common factor for both groups when differentiating AOM from OME, as 96% of ears and 93% of the images were assigned an AOM diagnosis with bulging vs. 0% and 3%, respectively, in the OME groups.

“In reaffirming long-established diagnostic verities, the present findings underscore the importance of [tympanic membrane] bulging as a telltale and virtually invariable finding in children with AOM,” the researchers wrote. “The findings point to the advisability under most circumstances of restricting antimicrobial treatment for AOM to children who have [tympanic membrane] bulging, and they call into question clinical trials of the treatment of AOM in which [tympanic membrane] bulging has not been a required element for participation.”

A study published earlier this year had similar diagnostic findings as this group. In that study, within 1 month of symptom onset for AOM, the tympanic membrane was most frequently described as “mild bulging” followed by “bulging.” In more than half of the 126 bilateral AOM episodes in that study, inflammation in both tympanic membranes was recorded at different periods of the infection.

Disclosure: The researchers report no relevant financial disclosures.

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