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INTRODUCTION

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Ear pain, or otalgia, is one of the most common pediatric outpatient chief complaints. The differential diagnosis is listed in Table 118-1. This chapter discusses acute otitis media, otitis media with effusion, otitis externa, acute mastoiditis, and foreign body. Anatomically, the ear is divided into three major parts: (1) the outer ear, which includes the auricle and the external auditory canal; (2) the middle ear, which is bound by the tympanic membrane laterally, contains the auditory ossicles, and is connected to the nasopharynx via the eustachian tube; and (3) the inner ear, which includes the semicircular canals, the cochlea, and the auditory nerve (Figure 118-1).

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TABLE 118-1Differential Diagnosis of Acute Ear Pain
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FIGURE 118-1.

Anatomy of the outer, middle, and inner ear.

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ACUTE OTITIS MEDIA

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EPIDEMIOLOGY

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Otitis media is a general term used to describe inflammation within the middle ear, and acute otitis media (AOM) specifically refers to the acute onset of signs and symptoms of middle ear inflammation. Otitis media is one of the two most common diagnoses for outpatient sick visits in children under 15 years old, accounting for 7.4% of all ED visits,1 and is second only to acute upper respiratory infection.2 However, visits appear to be decreasing due to a combination of increased financial barriers to care, improved public education regarding the viral nature of most infectious diseases, and the administration of contemporary pneumococcal and influenza vaccines.3

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The peak incidence of AOM is between 6 and 18 months of age.4 In the United States, up to 50% of children will have had at least one episode of AOM by the age of 1 year.5 The incidence is higher in children who are Native Americans, Eskimos, males, day care attendees, exposed to tobacco smoke, born with craniofacial anomalies, prone position sleepers, pacifier users, or born with immunodeficiency syndromes.4,5 The incidence is also higher in infants who are diagnosed with their first episode of AOM before 6 months of age. Breastfed infants have a lower incidence of AOM compared to infants who are formula-fed.5

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PATHOPHYSIOLOGY

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