Acute Otitis Media with Scant Erythema

Acute Otitis Media with Scant Erythema

A 4-year-old previously healthy male is brought to the pediatric clinic by his mother. The child has had 3 days of cough, congestion, and fever. Yesterday, he began to develop left ear pain. His mother has been treating the symptoms with over-the-counter analgesics.

On exam, he is an active young man with a cough and runny nose. His temperature is normal. This image is obtained with the Wispr digital otoscope.

What is your diagnosis and what action should be taken?

The child has acute otitis media. Antibiotics should be considered.

The hallmark of acute otitis media (AOM) is the bulging ear drum, as seen in this case. The bulging is caused by increased pressure due to inflammation in the middle ear space. The appearance is often described as an angry bagel. The dimple in the middle is caused by the attachment of the umbo which is the distal portion of the malleus ossicle. Generally, there is intense erythema (redness) associated with an ear infection. The erythema is caused by increased vasculature along the tympanic membrane. What is interesting about this case is that scant erythema is present. Despite this, the vasculature is quite pronounced. Compare this case of AOM to a normal ear shown here.

WiscMed has published a visual diagnosis guide to common ear conditions.  This guide can be downloaded as a pdf here.