A 3-year-old with a history of chronic middle ear effusion is brought in by her mother to the pediatric clinic with concern for ear discomfort. This image is obtained. What is your diagnosis?
The child has a middle ear effusion.
A significant challenge in otoscopy is seeing the difference between acute otitis media (AOM) and a middle ear effusion (MEE). The key point of differentiation is the presence of bulging of the eardrum. Bulging indicates increased pressure in the middle ear space and is the hallmark of AOM. In this clinical case, there is no bulging, but there are clearly air-fluid levels consistent with MEE. In addition, the eardrum does not look “angry”, i.e. it is not erythematous and the vasculature is not prominent. For this case, no treatment is indicated. Compare this with bullous myringitis, a significant infection that results in blistering of the eardrum.
Middle Ear Effusion (MEE)
Acute Otitis Media (AOM)
The attending physician reports that the mother didn’t initially understand the meaning of a middle ear effusion. However, when the mother was shown this picture, they were able to have a reassuring discussion of MEE and why it did not require treatment.