A 4-year-old female is brought in by her mother to the pediatric clinic. The child has been complaining of right ear pain for a day. The mother indicates that the child had several days of viral symptoms including cough, runny nose, and temperatures to 100.5 F. Yesterday, the child began pulling at her right ear and complaining of pain. The child has a history of “ear infections”. The mother has been treating the symptoms with over-the-counter analgesics.
On exam, the child is afebrile with rhinorrhea. She is alert and cooperative but appears “punky.” She says her right ear hurts. This image of her right ear is obtained with the Wispr digital otoscope. What treatment is indicated?
The child has acute otitis media (AOM). Antibiotics should be considered.
This Wispr otoscope image demonstrates all the hallmarks of an ear infection. There is bulging of the tympanic membrane (ear drum) and the umbo dimple is present due to the bulging. Bony landmarks are lost as there is only the hint of the lateral process of the malleus bone. In addition, there is pronounced vasculature of the eardrum leading to an erythematous (red) appearance. Compare this case of AOM with a normal ear. The normal eardrum has no bulging, is concave, it is not red, and the bones of the middle ear are easily appreciated.
Right Ear with AOM
Normal Left Ear
The case presented here is “classic.” The prodrome of AOM is often a viral infection. This infection leads to Eustachian tube dysfunction which creates an environment where bacterial infection and inflammation produce fluid in the middle ear space. Because the Eustachian tube is not functioning, the fluid creates pressure in the middle ear space resulting in bulging of the ear drum. The symptoms of this bulging include pain and decreased hearing. Antibiotics should be considered for this condition. If the child continues to have recurrent ear infections, ventilation tubes may be considered. Ventilation tubes are placed thru the tympanic membrane to drain and ventilate the middle ear space.
WiscMed has produced a visual guide to ear conditions that may be found here.