Weiss J C, Yates G R, Quinn L D
Phoenix Children's Hospital, Arizona, USA.
Am Fam Physician. 1996 Mar;53(4):1200-6.
The diagnosis of acute suppurative otitis media is not as easy and straightforward as it may seem. Many of the signs and symptoms in children with acute otitis media are also observed in children without it. Furthermore, several of the "classic" findings of acute otitis media, such as fever and earache, are often absent, even in cases confirmed by myringotomy. An otoscope with a fresh bulb and a good power source, as well as a view of the tympanic membrane that is not obstructed by cerumen, are essential to making the diagnosis of acute otitis media. A bulging, cloudy, immobile tympanic membrane is highly associated with otitis media. Erythema of the eardrum alone, however, is often the result of viral infection, crying or attempts to remove cerumen and should not be the sole basis for the diagnosis of acute otitis media. To avoid the common problem of overdiagnosing acute otitis media, the clinician should consider the predictive values of the various symptoms and physical examination findings associated with ear infections.
急性化脓性中耳炎的诊断并非像看上去那么简单直接。许多患有急性中耳炎的儿童的体征和症状，在未患该病的儿童中也会出现。此外，急性中耳炎的一些“典型”表现，如发热和耳痛，即使在鼓膜切开术确诊的病例中也常常不存在。一个带有新灯泡和良好电源的耳镜，以及鼓膜视野不被耵聍阻挡，对于急性中耳炎的诊断至关重要。鼓膜膨出、浑浊、活动受限与中耳炎高度相关。然而，仅鼓膜充血往往是病毒感染、哭闹或试图清除耵聍的结果，不应作为急性中耳炎诊断的唯一依据。为避免过度诊断急性中耳炎这一常见问题，临床医生应考虑与耳部感染相关的各种症状和体格检查结果的预测价值。
