Resolving Acute Otitis Media
A 3-year-old male presents for reevaluation 3 days after being diagnosed with acute otitis media (AOM). The mother reports that the child has had frequent ear infections in the past. 3 days ago, he presented to urgent care with fevers and left ear pain. Prior to the ear pain developing he had viral symptoms including congestion, cough and a sore throat. At the visit 3 days ago, he was placed on an antibiotic for AOM. The mother reports that today he is “back to normal,” with high energy and a good appetite. Examination of his left ear reveals this image. Is any further intervention necessary?
The child’s acute otitis media is resolving as expected. No further intervention is indicated. The complete course of prescribed antibiotics should be taken.
The child’s exam reveals evidence of resolving AOM. The short process of the malleus is partially discernable, although it’s definition is still not that of a normal ear. There is mild bulging of the pars tensa portion of the tympanic membrane (TM) (compare with significant bulging seen here) along with bulging of the pars flaccida portion of the TM. There is an air-fluid level present suggesting that the Eustachian tube has started to allow ventilation of the middle ear space. Overall, this image is consistent with the natural history of AOM resolution.
Here is a comparison of the patients left ear with resolving AOM and his normal right ear:
Here is the complete video of the left ear exam:
Complete exam video