Laboratory Testing for Recurrent Otitis Media
Laboratory tests are not routinely needed for patients with recurrent acute otitis media (rAOM), as the diagnosis is clinical and based on history, physical examination, and pneumatic otoscopy findings. 1
Clinical Diagnosis Without Laboratory Testing
The microbiologic diagnosis of acute otitis media can only be made by tympanocentesis and culture of middle ear effusion (MEE)—not by routine laboratory tests. 1
Cultures of throat and nasopharyngeal swab specimens are of no value because they are neither sensitive nor specific when compared with cultures of isolates from the middle ear. 1
Clinical assessment should include history and physical examination, with documentation of symptoms and signs including fever, obtained at 3-5 days after initiation of therapy. 1
When Tympanocentesis May Be Indicated
Tympanocentesis is a safe procedure when performed by skilled and experienced persons and should be reserved for specific clinical scenarios rather than routine evaluation. 1
The procedure provides:
- Specific microbiologic diagnosis to guide antibiotic selection 1
- Symptomatic relief of acute pain by decompressing the middle ear 1
Consider tympanocentesis in these situations:
- Treatment failure after appropriate antibiotic therapy 1, 2
- Severe or complicated cases requiring precise pathogen identification 1
- Immunocompromised patients where specific organism identification is critical 1
Audiometric Testing Recommendations
Hearing testing is recommended when middle ear effusion persists for three months or longer, or at any time that language delay, learning problems, or significant hearing loss is suspected. 1
Initial hearing testing for children at least four years of age can be conducted in the primary care setting in a quiet environment. 1
Comprehensive audiologic examination is recommended for children who fail primary care testing, are younger than four years, or cannot be tested in the primary care setting. 1
Tympanometry provides objective evidence of middle ear status and presence or absence of fluid, though technical difficulties limit its use in children during the first 6 months of life. 1
Common Pitfalls to Avoid
Do not order routine blood work, inflammatory markers, or immune function tests for uncomplicated rAOM—these do not change management and are not recommended by guidelines. 1
Do not rely on nasopharyngeal or throat cultures to guide antibiotic selection, as approximately 20% of cases show disparate results between the two ears. 1
Avoid ordering laboratory tests when the clinical diagnosis is clear based on pneumatic otoscopy showing moderate-to-severe bulging of the tympanic membrane with recent onset of ear pain or intense erythema. 1