Improving the Diagnosis of Otitis Media (Ear Infection) in Pediatric Patients

Monday, November 29, 2021

​​Waking up in the middle of the night to a crying child suffering from an ear infection is an all too familiar event for many parents. In fact, most parents would not be surprised to learn that otitis media (ear infection) is the No. 1 cause for pediatric office visits, the No. 1 cause for antibiotic use in children, and the No. 1 cause for surgery in children.

Boys Town National Research Hospital is leading the way to discover new techniques that can determine the level and type of fluid in a child's middle ear, as well as whether the cause is bacteria, a virus, or fluid build-up due to anatomical differences in a child's middle ear. Having improved diagnostic tools will help physicians deliver the most accurate diagnosis and care plan for their patients.

Improving Otitis Media Care and Treatment

• Placing tubes in ​a child's ear, while a common procedure, is still a big deal for the child and parents. At Boys Town Ear, Nose and Throat, we deal with this every day. With the help of volunteer families, our researchers were able to gain valuable knowledge by examining and testing children before and after tubes were placed. We'll use this research to better understand how fluid in the ear affects hearing, and to determine the best treatments for ear infections.
• To ensure proper treatment, getting an accurate diagnosis is vital, but making that diagnosis as simple and objective as possible is important when dealing with young children. The Boys Town research team is studying a new objective middle-ear test that involves simply placing an ear tip with a microphone in a child's ear. This new method gives us valuable information about middle-ear status, lessening the chance for a misdiagnosis.
• Lastly, we are researching ways to refine the information we get from our advanced diagnostic techniques. This involves applying computational models to the data we get from an exam on a child with an ear infection to further improve the new diagnostic tools we are developing.

Accurate Diagnosis Means Improved Outcomes

Getting the diagnosis right is of the utmost importance. While doctors do an admirable job of diagnosing and treating otitis media, there's a need for more accurate measures that can determine the level and type of fluid in a child's middle ear, as well as whether the cause is bacteria, a virus, or fluid build-up due to the dysfunction of the child's middle ear.

The Boys Town Center for Hearing Research is leading the way to discover new techniques. 

"We want to better understand ear infections and differentiate between causes more effectively," said Gabrielle Merchant, Au.D., Ph.D., Director of the Translational Auditory Physiology and Perception Laboratory. "By improving the diagnosis, we are improving the treatment and ultimately improving the lives of children."

Three Recent Research Papers

The Center for Hearing Research recently published three papers on improving diagnostic testing for otitis media.

"Our goal is to find objective ways to say 'yes, there's an ear infection' or 'no, there is not bacteria present' or 'it is caused by a virus,'" Dr. Merchant said. "Ultimately, we want to avoid unnecessary surgeries or unnecessary use of antibiotics while ensuring the child is properly treated."

The first paper, “Audiologic Profiles of Children with Otitis Media with Effusion," illustrates research done with children recruited from ear, nose and throat clinics who were having tubes placed. 

The researchers first perform a battery of standard hearing tests, including tympanometry and behavioral audiometric testing, following up with experimental tests that are FDA-approved.

After the tubes are placed, the effusion is studied for the type and amount of fluid present, which is then compared to the results from testing. This work found that the amount, or volume, of effusion is an important determinant of the impact a given episode of otitis media has on a child's hearing. 

The second paper, “Improving the Differential Diagnosis of Otitis Media with Effusion Using Wideband Acoustic Immittance (WAI)," utilizes a relatively new diagnostic tool called wideband acoustic immittance (WAI). WAI measures how the ear drum is moving in an affected ear. This, in turn, can tell us things about what is happening behind the ear drum. This paper found that WAI could determine the volume of effusion in a child's ear. This is particularly significant given the findings of the first paper, which demonstrated that volume is an important factor as to how a child is hearing. 

"It's quick and easy," Dr. Merchant said. "We place a microphone in a child's ear, press a button, then take it out."

Dr. Merchant said that larger sample sizes are needed before moving this diagnostic tool to clinical settings. The advantage of WAI is that it takes the subjectivity out of assessment of ear drum and middle-ear status.

The third paper, “The Influence of Otitis Media with Effusion on Middle-Ear Impedance Estimated from Wideband Acoustic Immittance Measurements," takes WAI testing further by applying computational models to the findings from the first and second papers to improve the diagnostic utility of WAI further. The models estimate characteristics of the ear canal and help isolate the influence of the effusion and ear infection on the ear drum motion, all to drive and maximize precision and accuracy.