A six-year-old female is brought into the pediatric clinic for evaluation of ear pain. Four days ago, the child began to have cough, rhinorrhea, and throat pain. Two days ago she was evaluated at urgent care where a rapid strep was negative and she was diagnosed with a viral infection. Since that visit, the child continues to have a temperature to 39 C, now with bilateral ear pain. The parents have been treating the child with over-the-counter analgesics which temporarily help with the symptoms. The following image of her right ear was obtained with the Wispr digital otoscope.
What is your diagnosis and treatment?
The child has acute otitis media and antibiotics should be considered.
This is one of the most common reasons for a pediatric visit, a viral syndrome that may evolve into acute otitis media with ear pain. This patient has bilateral acute otitis media as the images below demonstrate.
AOM – left ear
AOM – right ear
What starts as an apparent viral infection can lead to obstruction of the Eustachian tubes. The Eustachian tubes vent the middle ear space to the posterior nasal pharynx. When this tube becomes blocked, it’s possible for a bacterial co-infection to take place. A consequence of the infection and blockage is the bulging of the tympanic membrane (ear drum) because the pressure on the “inside” of the ear is higher than the external air pressure. The other features of the infection are erythema (redness) and loss of the bony landmarks. The umbo dimple is often prominent and makes the entire eardrum look like an “angry donut.” It looks painful, and it is. Hearing is often diminished because the eardrum is not able to vibrate normally.
After initiation of antibiotics, the symptoms of AOM (pain, fever, hearing decrease) generally resolve quickly while the physical findings may take several weeks to return to normal as shown here.
Here is the complete video exam of both ears. Note the ability of the Wispr otoscope to navigate the small canals partially occluded by cerumen (wax).