Ear Pain – September 28, 2023

Ear Pain – September 28, 2023

A 3-year-old presents to the emergency department (ED) with a complaint of ear pain for the past several hours. She had previously seemed fine except for a runny nose for the past week. The pain was severe enough to wake her from sleep and she has been crying while waiting in the exam room. In the ED her temperature is 38.5 C, her respiratory rate is 30, and Pox is 98%. She has mild rhinorrhea, but her breath sounds are clear.

Her Wispr exam is noted below.

Which of the following is the primary indication for immediate treatment with antibiotics?

  1. Fever > 38 C
  2. Ear pain
  3. The child’s age
  4. The appearance of the tympanic membrane (TM)

Answer B – Ear pain

The child has acute otitis media (AOM) as evidenced by severe bulging. While the severity of the bulging is impressive enough to diagnosis AOM, current AAP guidelines utilize illness severity (degree of pain and height of fever), duration, and age as factors in determining when to initiate treatment with antibiotics. When symptoms are severe, age and duration become less important. Therefore, in this case, the presence of severe ear pain would be the primary indication for beginning antibiotics immediately (while also providing adequate pain relief).

The clinician should prescribe antibiotic therapy for AOM (bilateral or unilateral) in children 6 months and older with severe signs or symptoms (ie, moderate or severe otalgia or otalgia for at least 48 hours, or temperature 39°C [102.2°F] or higher).

 Lieberthal AS, Carroll AE, Chonmaitree T, et al. Clinical Practice Guideline: The Diagnosis and Management of Acute Otitis Media. Pediatrics. 2013

WiscMed has created a visual diagnosis of ear conditions that may be found here.

Here is the complete video exam.


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