A 4-year-old female is brought in by her parents to the pediatric clinic. The child has complained of ear pain since last night. Three days ago, she began to experience viral symptoms, including a cough, runny nose, fever and congestion. The parents had been successfully treating the symptoms with over-the-counter analgesics. She appeared to be getting better until the ear pain began. The parents are concerned because her older brother had a history of ear infections and required ear tubes. On exam, the child appears ill without being toxic. She responds well and appropriately resists examination. The image of her painful ear taken with the WiscMed Wispr digital otoscope is shown. What is the next step in management?
The child has acute otitis media (AOM). Antibiotics should be considered.
The hallmarks of AOM include a bulging ear drum, loss of bony landmarks, pronounced vasculature and erythema (redness), and pain. This image clearly demonstrates the physical exam findings of bulging and pronounced vasculature. The umbo dimple is caused by the attachment of the distal portion of the malleus to the ear drum. AOM is often described as looking like an “angry donut.” The bulging is caused by blockage of the Eustachian tube which prevents proper ventilation and pressure equalization across the eardrum in the middle ear space. Antibiotics should be considered for this condition. After initiation of treatment, the pain generally resolves in a day. The physical findings can take up to three weeks to resolve. WiscMed has created a daily visual image series of the resolution of AOM which can be found here.