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• W4247047267 abstract "To The Editor: We read with interest Dr. Wald’s 1 excellent article in the February 2003 issue of the journal regarding the necessity for consensus among study investigators for the diagnosis of acute otitis media (AOM). The primary need for this definition is to exclude cases of otitis media with effusion (OME) which respond poorly to antibiotic therapy and, if included in treatment studies of AOM, skew the results negatively with regard to treatment efficacy. We agree with Dr. Wald and others 2, 3 that the most important diagnostic otoscopic sign of AOM, and the one that correlates best with a positive culture for bacteria in the middle ear, is fullness or bulging of the tympanic membrane (TM). It would therefore seem logical that only those TMs that satisfy at least this criterion should be included in future studies of AOM. This inclusion of only bulging TMs would miss some cases of early AOM but would exclude nearly all cases of OME. We agree with Dr. Wald that pneumatic otoscopy is not necessary to diagnose every case of AOM given that this adjuvant is helpful only in determining whether or not fluid is present and is superfluous in the case of a visibly full or bulging TM. In a study two of us published many years ago, 4 fluid was present, and usually exuding as if under pressure, in 112 of 113 myringotomies when the TM was bulging, as determined by the absence of bony landmarks. In addition to being unnecessary with a bulging TM, pneumatic otoscopy can be painful, making patient cooperation more difficult to obtain at the recheck visit when determining the movement of the TM may be critical in diagnosing OME vs. a normal TM. We are disappointed that the current literature bias has not stressed how best to determine whether the TM is truly full or bulging, i.e., its position. As has been pointed out by us 5 and others, 6 the single most important landmark is the prominence (or lack thereof) of the short, or lateral, process of the malleus. Brenneman wisely wrote in 1931 that “the practical measure of bulging is obliteration of the short process, the diagnostic role of which cannot be overemphasized.”7 Because the prominence of the short process is the most objective and helpful sign in determining the position of the TM, a description of it should be included whenever a diagnosis of AOM is made. More emphasis on this sign in current day teaching would greatly improve the accuracy of the diagnosis of AOM, especially with regard to students, house staff and emergency room physicians. Oliver F. Roddey Jr., M.D. Hunter A. Hoover, M.D. Ralph Earle Jr., M.D." @default.
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• W4247047267 date "2003-07-01" @default.
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• W4247047267 doi "https://doi.org/10.1097/00006454-200307000-00028" @default.
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