Ingvarsson L
Acta Paediatr Scand. 1982 Sep;71(5):705-10. doi: 10.1111/j.1651-2227.1982.tb09507.x.
One hundred and seventy-one children up to 15 years of age and with acute otalgia were examined to find out whether otalgia or any other symptoms were so closely related to acute otitis media (AOM) as to make otoscopic examination unnecessary. AOM was diagnosed in 46%, simplex otitis in 15%, serous otitis media (SOM) in 17%, and normal eardrums in 22%. Children with AOM had fever and spontaneous perforation of the eardrums in 78% and 30% of the cases, respectively. Of the children who had not AOM (54%), the otalgia could in most cases be classified as referred pain due to, for instance, discomfort when swallowing, nasal obstruction or throat pain. Other reasons were general irritability due to fever, teething or moderate hearing loss. The difficulties in diagnosing AOM simply on the basis of symptoms were demonstrated in the investigation. Symptoms such as otalgia, otorrhea, fever or upper respiratory tract infection (URI), possibly except for the combination of otorrhea and fever, can occur without AOM. A correct otoscopic examination and evaluation of the eardrums is necessary in children with otalgia, other symptoms of URI or in doubtful cases of acute illness. Physicians without possibilities to evaluate the eardrums properly should thus refer the patient to an otologist without delay.
对171名15岁及以下患有急性耳痛的儿童进行了检查，以确定耳痛或其他任何症状是否与急性中耳炎（AOM）密切相关，从而无需进行耳镜检查。诊断为AOM的占46%，单纯性中耳炎占15%，浆液性中耳炎（SOM）占17%，鼓膜正常的占22%。患有AOM的儿童中，分别有78%和30%的病例出现发热和鼓膜自发穿孔。在未患AOM的儿童（54%）中，大多数情况下耳痛可归类为牵涉痛，例如吞咽不适、鼻塞或咽痛所致。其他原因包括发热、出牙或中度听力损失引起的全身易激惹。该调查表明仅根据症状诊断AOM存在困难。耳痛、耳漏、发热或上呼吸道感染（URI）等症状，可能除了耳漏和发热同时出现外，在没有AOM的情况下也可能出现。对于有耳痛、URI其他症状或急性疾病可疑病例的儿童，进行正确的耳镜检查和鼓膜评估是必要的。因此，无法正确评估鼓膜的医生应立即将患者转诊给耳鼻喉科医生。
