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Cases

Acute Otitis Media

Acute Otitis Media

A 13-month-old male is brought in by his parents with concern for fever and fussiness. They report that the symptoms began about 3 days ago with a cough and runny nose. The infant’s temperature has been as high as 39 C at home and he has responded well to antipyretics. The child continues to drink, but with less enthusiasm. He continues to have wet diapers. He is up-to-date on immunizations. The mother works in the hospital and is concerned about the possible transmission of COVID to her son although no one else in the family is symptomatic. On exam, the child is well-appearing. He drools, has brisk capillary refill, and appropriately resists the exam with surprising ingenuity and strength. He is easily comforted in his mother’s arms. Examination of his right ear reveals this image.

The child has acute otitis media.

The Wispr Digital Otoscope image clearly reveals acute otitis media. The key characteristics are bulging (angry doughnut), erythema (redness), and loss of bony landmarks. Laboratory testing included Respiratory Syncytial Virus (RSV) and COVID swabs. COVID came back negative, but the RSV was positive. This is a common scenario in the late summer and early fall of 2021. For much of the COVID pandemic, RSV was rarely seen. It is now prevalent and the frequent cause of presentation to primary care. A reasonable question would be given that RSV (a virus) is positive, should antibiotics be initiated? Often with RSV, there is bacterial co-infection in the middle ear space. For this reason, even with a positive RSV diagnosis, consideration of antibiotics with acute otitis media is appropriate.

Notable with this child, and any grumpy child is the challenge of obtaining a good ear exam. The power of the Wispr digital otoscope is its ability to not only access the smallest ear canals but also its ability to record the exam. With the exam being recorded, the provider can focus on accessing the tympanic membrane without having to worry about mentally processing the view in real-time. After the exam, the video can be reviewed and frames of interest exported for discussion with the family or inclusion in the medical chart.

Here is the recorded video exam of this patient:

Complete exam video