3-year-old with a Cough

A 3-year-old presented to her pediatrician’s office with complaints of cough and congestion for the previous 5 days. Her mother reported the child has had “nonstop colds” since starting daycare. She was seen in an urgent care two weeks ago after waking during the night with a fever. The mother denies any current fever. In the clinic, the child is well-appearing with clear rhinorrhea and mild wheezes bilaterally, but normal work of breathing. Her Wispr digital otoscope exam is attached. 

Which of the following is true regarding the child’s tympanic membrane (TM) findings?

A. She has acute otitis media (AOM)
B. She has evidence of a recent AOM
C. Her TM is moderately bulging
D. Her TM is normal

The child’s TM is mildly bulging, and there is a small mucopurulent patch inferiorly. These findings suggest the TM was recently infected and is in the resolution phase of healing.  The TM also appears slightly “full,” and the malleus is difficult to clearly visualize due to bulging superiorly and dullness of the membrane (note the lack of light reflex). With mild bulging, AOM diagnosis requires additional clinical support, including pain or intense erythema of the TM. Neither is found in this case.  Likewise, the child’s TM is not moderately to severely bulging (taking the appearance of an “angry donut”) and should not be diagnosed with AOM.