The kx~rnal of Emergency Medune. Vol 4, pp 415-416 1986 Prtnted in the USA l CopyrIght ‘- 1986 Pergamon Jourr,als Ltd

0 On Blowing in the Ear

I would like to bring to the attention of the authors of the interesting and infor- mative article, “Variability in the Man- agement of the Febrile Infant Under 2 Months,“’ and of the editors who com- mented on the article that tympanometry and pneumomassage are not completely valid in infants under 7 months. Paracen- tesis of the middle ear may be required if the examiner is uncertain about the pres- ence of fluid in this age group. If the au- thors and the editors are aware of newer techniques of tympanometry or pneumo- massage that demonstrate fluid in this age group, I would appreciate the reference.

Paradise and colleagues state, “In in- fants less that 7 months of age, many ears with effusion had normal tympanograms, presumably because the external auditory

I Berkowitz CD, Orr DP, Uchiyama N, et al: Varia- bility in the management of the febrile infant un- der 2 months. JEmerg Med 1985; 3:345.

2. Paradise JL, Smith CC, Bluestone C: Tympano- metric detection of middle ear effusion in young infants and children. Pediatrics 1976; 58: 198.

0 Blowing Versus Admitting

The concerns raised by Dr Mofensen are valid. The difficulty of assessing the mid- dle ear in young infants is well recognized, and a normal tympanogram in a young

canal walls in such infants tend to be high- ly distensible.“? Northern makes a similar statement,’ and the Task Force of the Symposia on Impedence Screening reaf- firms the statement .J

I think the readers should be aware of the variability of response to tympanom- etry and peneumomassage in this age group. Although pneumoscopy is recommended in evaluation for middle ear fluid, its val- ue under 7 months is limited by the disten- sibility of the walls of the auditory canal.

Howard C. Mofenson, MD, FAAP, FACT

Professor of Clinical Pediatrics SUNY at Stony Brook

Director Long Island Regional Poison

Control Center Nassau County Medical Center East Meadow, New York 11554

3. Northern JL: Advanced techniques for measuring middle ear function. Pediafrics 1978; 61: 763.

4. Task Force of the Symposium on Impedence screening for children: Use of acoustic impedence measurement for middle ear disease in children. Pediarrics 1978; 62: 570.

infant does not preclude the presence of acute otitis media.’

The major question actually deals with the appropriate management of young infants suspected of having otitis media. We again concur with Dr Mofensen and

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416 The Journal of Emergency Medicine

other investigators who maintain that young infants under 3 months with sus- pected otitis media be evaluated with a tympanocentesis.2

The need to manage these infants with antibiotics is well accepted, but the need for routine hospitalization of febrile in- fants under 2-3 months of age with otitis

media is not.“.s We await future studies to resolve this question.

Carol D. Berkowitz, MD

Director, Pediatric Clinic and Group Practice

Harbor/UCLA Medical Center Associate Professor of Pediatrics

UCLA School of Medicine

REFERENCES

1. Paradise JL, Smith CC, Bluestone C: Tympano- metric detection of middle ear effusion in young infants and children. Pediafrtics 1976; 58:198-210.

2. Tetzlaff TR, Ashworth C, Nelson JD: Otitis me- dia in children less than 12 weeks of age. Pediut- rics 1977; 59:827-832.

3. Shurin PA, Howie WM, Pelton SI, et al: Bacterial etiology of otitis media during the first six weeks

of life. J Pediatr 1978; 92:893-896. 4. Klein JO, Bluestone CD: Acute otitis media. Spe-

cial series: Management of pediatric infectious diseases in office practice. J Pediatr Infect Dis 1982; 1~67-73.

5. Berkowitz CD, Uchiyama N, Tully SB, et al. Fever in infants less than two months of age: Spectrum of disease and predictors of outcome. Pediatr Emerg Care I; 1985:128-135.