grading system for severity of AOM
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  Grading the Severity of AOM

At UTMB we have developed a scoring system to grade the severity of the AOM. This is not a universally recognized system, but we use it to distinguish the more severe from the less severe cases. There is evidence in the literature that mild otitis media will often clear without antibiotics.

The key features of our scoring system include:

1. Body Temperature
    Scored on a scale of 1-7 based on increasing temperature. Body temperature can be used as another indicator of severity. Include this score with the symptom scores generated from the parent questionnaire to assess severity of the illness.

Fahrenheit scale

Scores:

1 2 3 4 5 6 7 transparent.gif (43 bytes)
Skin 96.96.9 97-97.9 98-98.9 99-99.9 100-100.9 101-101.9 ³102
Oral 97-97.9 98-98.9 99-99.9 100-100.9 101-101.9 102-102.9 ³103
Rectal 98-98.9 99-99.9 100-100.9 101-101.9 102-102.9 103-103.9 ³104
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Centigrade scale

Scores:

1 2 3 4 5 6 7 transparent.gif (43 bytes)
Skin 35.5-36.0 36.1-36.6 36.7-37.2 37.3-37.7 37.8-38.3 38.4-38.8 ³38.9
Oral 36.1-36.6 36.7-37.2 37.3-37.7 37.8-38.3 38.4-38.8 38.9-39.3 ³39.4
Rectal 36.7-37.2 37.3-37.7 37.8-38.3 38.4-38.8 38.9-39.3 39.4-39.9 ³40.0
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2. History
    A problem-focused history is taken to identify symptoms, parent's perception of illness, and risk factors.
   

3. Tympanometry 
    Before you can understand our scoring system for the tympanogram, you may need to learn more about tympanometry and how the tympanogram is interpreted.  Link here to review tympanometry and link here to exercises to practice reading tympanograms

    The patient's tympanogram is scored using these criteria. Research has shown that a score of 1 is not likely to be associated with a middle ear effusion. Ears with a score of 4 have about a 65% chance of being filled with fluid. Ears at the 7 level have a 95% chance of having middle ear fluid.

Score

Definition

1. Compliance > 0.2 and Gradient < 150 daPa
4. Compliance < 0.2 and Gradient < 150 daPa
      or
Compliance > 0.2 and Gradient  >150 daPa
7. Compliance < 0.2 and Gradient > 150 daPa

4. Appearance of the Tympanic Membrane

The appearance of the tympanic membrane is graded for severity of disease using the 7-point scale below.  
After studying the table below showing the severity gradings (0-7) and viewing the associated tympanograms,  please visit the exercise page to practice grading the severity of AOM.

POCKET GUIDE

Linked here is a pocket guide. One side is this Tympanic Membrane severity grading scale; the back side is the Symptom Severity analog scale referred to in another section of this module. 
click here:

Dr. McCormick wants to know if you are using this. Please drop a note to david.mccormick@utmb.edu.

 

 

Grade 0 - Not acute otitis media
Normal appearance or effusion
without erythema.

 

Grade 1 - Not acute otitis media
Erythema only,
No effusion, myringitis only


  

 


  

Grade 2 - Not acute otitis media
Erythema, air/fluid level 
clear fluid, no opacification

 
Grade 3 - Not acute otitis media
Erythema, complete effusion,
no opacification


  

 


  

Grade 4. ? Acute otitis media ?Erythema, opacification,
air fluid level or air bubble(s)
? mild bulging ?

 

Grade 5 ? Acute otitis media ?
Erythema, complete effusion,
opacification (no bubbles)
? mild bulging ?


  

 


  

Grade 6 - Acute otitis media
Erythema, bulging, rounded
doughnut appearance of tympanic membrane

 
Grade 7 - Acute otitis media
Erythema, bulging, bulla, complete effusion, opacification
 


  

 


  

   
  Please return to the exercise page.