Case Challenge: Acute Otitis Media in Children--Best Management Strategies

Gordon H. Sun, MD, MS


March 28, 2018

Toddler Ear Tugging

A 2-year-old girl was seen by a pediatric nurse practitioner in the ambulatory clinic. The girl's mother reported that her daughter had been fussing and pulling on her right ear for the past 2 days but had no fevers or lethargy. There were no recent sick contacts. The patient had no history of ear surgery. She was not taking any medications and had no known drug allergies.

The patient demonstrated normal vital signs. She appeared nontoxic and was breathing comfortably. She was awake, active, and tugging on her right ear. There was no erythema or edema of the right auricle or mastoid. Otoscopic exam of the right ear demonstrated a normal-appearing external auditory canal and an inflamed and bulging tympanic membrane. The tympanic membrane was immobile on pneumatic insufflation. No otorrhea was seen in the canal. The remainder of the physical exam, including left ear otoscopy, was unremarkable.


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