A 15 month-old-female is brought into the pediatrician’s office with concern for fever and ear-tugging. The child has been in day care where there have reportedly been kids sick with viral symptoms. Yesterday the child became “punky” with a fever of 102.5 F. The parents report that she has been pulling on her left ear. They have been treating the symptoms with over-the-counter analgesics. She does not have a history of ear infections. She continues to eat and drink but with less enthusiasm. On exam, she is an ill, but not toxic appearing child with rhinorrhea and a cough. She appropriately resists the exam. A Wispr digital otoscope provided this image of her left ear.
What is the next step in treatment?
The child has bullous myringitis. This is classified as a severe form of acute otitis media (AOM) with fever. Antibiotics should be started.
The child was started on antibiotics. At a follow-up appointment 3 days later, the eardrum had improved with the blistering resolved. There was still bulging of the eardrum but the child looked much better, and the fever was resolved.