CLINICAL CASES
CLINICAL CASES
Using the Wispr Digital Otoscope
3-year-old with a Routine Health Visit
A 3-year-old presented to her pediatrician’s office for a routine health visit. The mother stated her daughter had been in good health apart from continuous “daycare colds”, most recently one month prior. When she developed a fever, the child was seen in Urgent Care and prescribed an antibiotic for an ear infection. This was her first ear infection, and she completed the antibiotic course two weeks ago. The remainder of her past medical history was unremarkable without concern for hearing, balance, or language development. In the clinic, vital signs were appropriate for age. The child seemed to be a precocious preschooler and described (in extensive detail) her favorite toys. Her HEENT exam was notable for mild nasal congestion. The Wispr digital otoscope exam is attached.
Which of the following is the most appropriate management of this child’s condition?
A. A second course of antibiotics
B. An over-the-counter decongestant
C. A prescription for nasal corticosteroids
D. None of the above
D. None of the above
The child has otitis media with effusion (OME) as demonstrated by the air bubbles within an amber-colored middle ear effusion. There are no signs of inflammation; the tympanic membrane (TM) is not bulging. On the contrary, it appears slightly retracted, given that the lateral process of the malleus is quite prominent. Management for OME is supportive as there is no role for antibiotics, decongestants, or corticosteroids. OME is a prevalent pediatric condition with more than 60% of children experiencing at least one episode by 2 years of age. Children with cleft palate, Down syndrome, and obesity are at greater risk, as are those with exposure to tobacco smoke and daycare attendees. Most OMEs resolve spontaneously within 3 months and may be managed conservatively with attention to hearing concerns, balance problems, poor school performance, ear discomfort, or recurrent AOM.
