Acute Otitis Media – April 11, 2024

Acute Otitis Media – April 11, 2024

A 3-year-old female presents to the emergency department (ED) with ear pain and a temperature of 102o F.  Her mother reports her daughter initially complained of left ear pain last night, but this morning seemed to be holding her right ear. Her Wispr digital otoscope exam is shown.

Which of the following is true?

  1. The child has acute otitis media (AOM).
  2. The child should be initiated on a 7-day course of antibiotics.
  3. The image is of the child’s right tympanic membrane (TM).
  4. A & B
  5. All of the above

Answer: E

The child’s Wispr exam demonstrates moderate to severe bulging, evidenced by the donut appearance of the tympanic membrane (TM, “eardrum”). Given her symptoms of pain and fever, she should be started on antibiotics. The symptoms and physical exam are diagnostic of acute otitis media (AOM), an infection in the middle-ear space. Since she is older than two years of age, seven days is an appropriate duration of treatment. WiscMed has created a guide to AOM treatment that can be found here.

Determining the laterality of the TM is simpler when there is no bulging since the bony malleus orientation provides the necessary clue. Imagining the TM as a clock, the malleus represents one of the hands. If the hand points to the right side of the clock (roughly toward 2 o’clock), then it is the right TM. Conversely, if the hand points to the left side of the clock (roughly toward 10 o’clock) it is the left TM. Here is an illustration of this concept on a healthy and normal right TM.

With bulging from AOM, the bony landmarks become less obvious, and identifying laterality is more challenging. However, with knowledge of the normal malleus position, look for the tip of the lateral process as a small white “point” along the periphery. Recognition of these relationships makes the process simple. Thus the TM in question is from the child’s right ear. Note that if the bulging from AOM is severe, no portion of the malleus will be visible and determination of the laterality may be impossible from inspection alone.

Here is the complete video exam