Gordon H. Sun, MD, MS

April 29, 2014

Case Challenge 1: Otitis Media in a Young Child

A 5-year-old boy presents to his primary care provider with a mild right-sided earache over the past 24 hours. His parents report that he has not had any fever, drainage from the affected ear, or hearing loss, and is otherwise behaving normally. He is up to date on all childhood vaccines, including the pneumococcal conjugate (PCV13) vaccine. He has no history of otologic trauma or surgery, and no known drug allergies.

On presentation, the child appeared reasonably well and was cooperative. His temperature was 99.1°F (37.3°C), and all other vital signs are within normal parameters.

Examination revealed an inflamed, moderately bulging right-sided tympanic membrane with decreased mobility on pneumatic insufflation. The mastoid process was nontender and without edema. The left-sided ear examination was normal. The nasal passages were clear. The tonsils were not enlarged, and no purulence was noted. There was no cervical lymphadenitis. The remainder of the physical examination was normal.

The patient was diagnosed with acute otitis media (AOM). Consistent with American Academy of Pediatrics (AAP) guidelines,[1] he was not provided with immediate antibiotic therapy, and his parents were instructed to monitor him for the next 48-72 hours. They called 2 days later. Although the child was not clearly worse, he continued to experience right-side otalgia and has "felt warm" in the evenings.

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