7-year-old with Right Ear Pain

 A 7-year-old male presents to the pediatric clinic for a well-child check. His mother mentions incidentally that he has been complaining of pain in his right ear. The following image is obtained from the WiscMed Wispr digital otoscope.

What is the next step in management?

A. Start high-dose antibiotics
B. Refer the child to otolaryngology (ENT)
C. Perform tympanostomy
D. Parental reassurance

The child has bullous myringitis (BM). BM is characterized by bullae (blisters) along with acute otitis media (AOM). It is often considered a more “severe” form of AOM. The treatment for BM is the same as for AOM: high-dose antibiotics. An interesting feature of this case is that the bullae have shagrination (cobble-stoning). This feature is often associated with a change in the “pressure” of the blister, much like deflating a balloon causes wrinkles. 

There is no indication to refer the child to ENT, nor is there an indication to perform a tympanostomy (ear tubes). Parental reassurance without treatment is not appropriate in the context of bullous myringitis.  WiscMed has created a visual guide to common ear conditions that may be found here.

WiscMed thanks Dr. Daniel Lapidus, pediatric director of MyCare Pediatrics, for this week’s interesting case.

Here is the complete video exam