Middle Ear Effusion with Cerumen

Middle Ear Effusion with Cerumen

A 17-month-old presents to the emergency department (ED) with concern about an ear infection. The child had a runny nose and mild cough for several days and developed a fever on the evening of the presentation.

Aside from being treated the previous month for an ear infection, he is otherwise generally healthy and has not been pulling at his ears.

In the ED, he is a happy toddler with nasal congestion and a reassuring respiratory exam. His right ear Wispr exam is shown below.

What treatment is indicated?

The child has a middle ear effusion (fluid behind the eardrum). No treatment is indicated.

While not a normal appearing tympanic membrane (TM), this child does not have an ear infection, acute otitis media (AOM). His exam is consistent with a middle ear effusion (MEE) and does not require antibiotics at this time. Findings that support this assessment are the lack of TM bulging, no intense erythema (redness) of the TM, and no concern for a painful ear. In addition, the malleus is visible as are air-fluid levels that can be seen in the anterior-inferior portion of the TM. The air-fluid levels indicate the middle-ear space (behind the TM) is being ventilated by the Eustachian tube.

Here is another example of a MEE.

Below is the complete video exam. Note the impressive ability of the Wispr digital otoscope to navigate past significant cerumen without requiring cerumen removal.