A four-year-old female child is brought into the pediatric clinic by her father. She has had 3 days of a viral syndrome including cough, runny nose, and mild fever. Yesterday, she began to complain of right ear pain that seems to have been getting worse. The father has been treating the child with acetaminophen. The child has generally been in good health although the father reports occasional “ear problems.” On exam, the child looks uncomfortable but is alert and cooperative. This image of her right ear is obtained. What is your diagnosis and treatment?
The child has acute otitis media (AOM). Antibiotics should be considered.
Acute otitis media (AOM) is one of the top 3 reasons that children seek medical attention and the most common reason for antibiotic administration. This case describes a common situation, what appears to be a viral upper respiratory infection that develops into AOM. Although the child likely started with a viral infection, in a significant number of cases the ear infection also develops a bacterial component. For this reason, antibiotics are often considered for AOM.
Acute otitis media is diagnosed when bulging of the ear drum is present along with pain and potentially decreased hearing. In addition, there is often pronounced vasculature on the ear drum, as in this case. Compare this case of AOM to a normal eardrum below. Note that in the case of AOM, there is a loss of the bony landmarks due to the bulging of the ear drum. The bulging is caused by fluid in the middle ear space that can not drain because of Eustachian tube dysfunction.