CLINICAL CASES
CLINICAL CASES
Using the Wispr Digital Otoscope
4-year-old with Ear Pain and a Fever
A 4-year-old preschooler presented to Urgent Care with a complaint of ear pain and fever. Her mother reported the child had “a constant runny nose” since the beginning of the school year. She was fully vaccinated and otherwise generally healthy, but awoke late that evening with left ear pain. In triage, she appeared quite uncomfortable and was noted to have a fever of 39.5 °C. She has copious, clear rhinorrhea. Her Wispr digital exam is attached.
Which of the following best describes her tympanic membrane (TM) finding?
A. Mild bulging
B. Moderate/severe bulging
C. Cobblestoning
D. B & C
Answer: D. B & C
This child’s TM demonstrates an “angry donut” appearance of moderate to severe bulging. The anterior quadrants also show some scaley patches consistent with cobblestoning, or shagrination. Both findings are characteristic of acute otitis media (AOM), with case reports suggesting the latter may occur as TM bulging has reached its peak or is decompressing. However, as it has not been fully studied, the exact clinical significance of shagrination is not clear and treatment decisions ought to follow AAP guidelines based on age, severity of ear pain, and height of fever.
