From the Guidelines
Ear examinations in pediatric patients should begin at birth as part of routine newborn assessments and continue at every well-child visit throughout childhood. The initial examination evaluates for congenital abnormalities and proper ear formation. By 3-4 months of age, pneumatic otoscopy becomes important to assess middle ear function and detect early signs of otitis media. Regular hearing screenings should occur at birth, between 3-5 years of age, and then periodically throughout school years. For infants and young children, the proper technique involves gently pulling the pinna downward and backward, while in older children (over 3 years), pulling the pinna upward and backward provides better visualization of the tympanic membrane. Early and consistent ear examinations are crucial because hearing issues can significantly impact speech development, language acquisition, and learning. Additionally, recurrent ear infections, if left undetected, may lead to hearing loss or developmental delays, making routine ear checks an essential component of comprehensive pediatric care. According to the American Academy of Pediatrics, as stated in 1, regular surveillance of developmental milestones, auditory skills, parental concerns, and middle-ear status should be performed in the medical home, consistent with the AAP pediatric periodicity schedule. Furthermore, the 2007 position statement on principles and guidelines for early hearing detection and intervention programs, as mentioned in 1, emphasizes the importance of early intervention and surveillance in infants with hearing loss. The use of pneumatic otoscopy and tympanometry, as recommended in 1 and 1, is also essential in assessing middle ear function and detecting early signs of otitis media. Overall, the evidence suggests that early and consistent ear examinations, combined with regular hearing screenings and surveillance, are critical in promoting healthy hearing and language development in pediatric patients.
From the Research
Checking Ears in Pediatric Patients
- The ideal time to start checking ears in pediatric patients is not explicitly stated in the provided studies, but it can be inferred that ear checks should be performed when symptoms of otitis media are present 2, 3.
- Symptoms of acute otitis media (AOM) include otalgia, fever, or irritability, and a bulging tympanic membrane or otorrhea on physical examination 2.
- Watchful waiting may be appropriate in children 6 months or older with uncomplicated unilateral AOM 2.
- Tympanostomy tube placement is a common treatment for recurrent AOM, persistent AOM, or chronic otitis media with effusion (OME) 2, 3.
- Accurate diagnosis of otitis media is important to prevent suffering and complications when infection is present, and unnecessary antibiotic use when infection is absent 4.
- The usual signs and symptoms of AOM are unreliable guides in infants and young children, and diagnosis often depends on examination of the tympanic membrane with an otoscope 4.
Age-Related Considerations
- Children younger than 6 months may require more prompt treatment for AOM due to the higher risk of complications 2.
- Children older than 6 months with uncomplicated unilateral AOM may be candidates for watchful waiting 2.
- The effect of antimicrobial treatment on the duration of middle ear effusion (MEE) and concomitant hearing impairment has been studied in children between 6 months and 15 years of age 5.