Furthermore, the physician's assessment of TM mobility is completely subjective. Very few physicians use pneumatic otoscopy with any regularity.

Tympanometry is another diagnostic tool that identifies the presence of middle ear fluid. Although it provides accurate objective data, it too requires a perfect seal of the ear canal and an unobstructed view of the TM–two requirements that are not always easily achieved.

There is, however, yet another diagnostic modality available that, in this author's opinion, is the most practicable: acoustic reflectometry.

Acoustic reflectometry is a technology that determines the likelihood of a middle ear effusion based on the angle of a sound wave reflected off the TM. The test is performed quickly and painlessly using a portable handheld device approximately the size of an otoscope. In addition, the test does not require a perfect seal of the ear canal, nor does it require a completely unobstructed view of the TM.

Acoustic reflectometry correlates very closely with the results of tympanometry and is easier to perform.¹⁵

The device is so easy to use that a parental version is sold over the counter to enable parents to follow the course of their child's chronic ear effusions. When the device was introduced in 1997, it was described in Contemporary Pediatrics magazine as one of the best new products of the year. Acoustic reflectometry is also a reimbursable procedure, using the same code as tympanometry.

We hope this brief article will familiarize emergency physicians with the observation option for the treatment of AOM and re-acquaint them with the disease itself and the various nuances regarding its diagnosis.

A new treatment paradigm for AOM has the potential for dramatically decreasing antibiotic use for one of the most common pediatric diagnoses.

Contributor Disclosures

Contributors

Dr. Thomas F.X. Fischer is a clinical associate professor in the department of emergency medicine at Stony Brook University Hospital, Stony Brook, New York. Medical Editor Dr. Robert C. Solomon is an attending emergency physician at Trinity Health System in Steubenville, Ohio, and clinical assistant professor of emergency medicine at the West Virginia School of Osteopathic Medicine.

Disclosures

In accordance with the Accreditation Council for Continuing Medical Education (ACCME) Standards and American College of Emergency Physicians policy, contributors and editors must disclose to the program audience the existence of significant financial interests in or relationships with manufacturers of commercial products that might have a direct interest in the subject matter. Dr. Fischer and Dr. Solomon have disclosed that they have no significant relationships with or financial interests in any commercial companies that pertain to this educational activity. "Focus On: The Observation Option for Acute Otitis Media in the Emergency Department" has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME). ACEP is accredited by the ACCME to provide continuing medical education for physicians. ACEP designates this educational activity for a maximum of one Category 1 credit toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he or she actually spent in the educational activity. "Focus On: The Observation Option for Acute Otitis Media in the Emergency Department" is approved by ACEP for one ACEP Category 1 credit.