patient evaluation
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problem-focused history

holding the child


cleaning ear

tympanic membrane
(with practice exercises)

tympanic membrane videos for review

anatomy of the TM


Taking a problem-focused history specific to Otitis Media

A. Symptoms:
The parent/guardian should be allowed to provide his/her own history of the child's illness. A brief open-ended question, such as "Tell me about your child's problem," is usually sufficient to start the conversation. Our research with hundreds of patients with AOM indicates that a few key symptoms are highly correlated with the diagnosis. Our parents can check off the severity on a color-coded form: green (mild), yellow (more severe), and red (most severe). For each symptom such as fever, pain, feeding, sleeping, we assign a score, 0, 4 or 7, based on severity, in case the examiner wants to convert symptoms to a numeric score. Research indicates that clearing of the infection is associated with significant resolution of these key symptoms. Total scores can be computed which allow examiners to combine temperature, symptoms, tympanogram, and otoscopic assessment to obtain a total severity score for each child. This approach may assist clinicians in deciding about treatment options.

Symptoms 0 (Green) 4 (Yellow) 7 (Red)
1. Fever Less than 100.4 100.4-102.2 Greater than 102.2
2. Earache (Tugging) None Occasional Frequent
3. Irritability None Occasional Frequent
4. Feeding Feeds well Mild decrease in appetite Very poor appetite
5. Sleeping Normal Somewhat restless Very poor sleep

B. Parent Perception of Illness:
A simple analog scale marked by the parent/guardian correlates well with the parent's perception of the severity of the child's illness.

Linked here is a pocket guide. One side is this Symptom Severity analog scale; the back side is the Tympanic Membrane severity grading 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

C. Questions:
In addition, it is helpful to know whether the child has had prior ear surgery, and if there are any risk factors that may predispose to ear infection. Important risk factors are covered by the following questions:

  1. Was the child breast fed?
  2. Does the child attend day care?
  3. How large is the day-care group? How many hours per week?
  4. Is the child exposed to tobacco smoke?
  5. How many prior ear infections has the child experienced?
  6. How old was the child when his/her ear infections occurred?
  7. Has the child ever had ear tubes or surgery on his ears?
  8. Has the child recently been taking antibiotics? Is the child allergic to antibiotics?
  9. Has the child generally been healthy, or is there an underlying medical condition?
  10. Has the child received pneumococcal and influenza virus vaccine?