A college student has had congestion, runny nose, and a cough for several days. She then developed ear pain. She was tested for COVID and found to be negative. This image was obtained. Would you initiate antibiotics? Which ear is this?
The student has a middle ear effusion, antibiotics are not indicated. It is the left ear.
This is a common clinical scenario. Ear pain following several days of viral symptoms. The key to diagnosing a middle ear effusion is the presence of fluid and air-fluid levels behind the tympanic membrane. In addition, in an MEE the eardrum is not bulging as in acute otitis media (AOM). The presence of air-fluid levels indicates the Eustachian tube is functioning correctly, ventilating the “other side” of the tympanic membrane, or the middle ear space.