CLINICAL CASES
CLINICAL CASES
Using the Wispr Digital Otoscope
16-month-old with a Fever
A 16-month-old presented to the emergency department (ED) with fussiness and fever for one day. Her father reported the child had a runny nose and cough for the preceding week, but no fever until the evening of presentation. Her recent medical history was significant for an ear infection, for which she completed a course of “a pink antibiotic” one week ago. In the ED, she had a temperature of 103o F and appeared uncomfortable. Her Wispr digital exam of her tympanic membrane (TM) is shown.
Which of the following is (are) true regarding the child’s history and findings?
A. She has right acute otitis media (AOM)
B. Appropriate treatment is with azithromycin
C. Appropriate treatment is with amoxicillin-clavulanate antibiotic
D. She should be admitted for IV antibiotics
Answer: C. Appropriate treatment is with amoxicillin-clavulanate antibiotic
The child’s TM has the appearance of an “angry donut” characteristic of moderate to severe bulging, and may be confidently diagnosed with acute otitis media (AOM). Since she was treated with amoxicillin (the classic pink antibiotic) in the preceding month, appropriate management is amoxicillin-clavulanate (Augmentin) to expand coverage against B-lactamase producing bacteria. Azithromycin does not have such expanded coverage.
When visible, the malleus provides laterality of the TM as it points toward the side of the ear in question. However, when the TM is bulging to a significant degree, identifying this bony landmark can be challenging. In this case, the lateral process of the malleus is barely visible. A finding that provides malleus orientation in a severely bulging TM is a subtle cleft extending outward from the central depression. The depression results from the fixed attachment of the umbo, while the cleft is created by TM bulging “around” the body of the malleus. The cleft in this child’s TM extends toward the 10 o’clock position, demonstrating the AOM in question is in her left ear.
WiscMed has created a guide to AOM that can be found here.
