Acute Otitis Media

An 18-month-old female is brought into the pediatric clinic by Dad with fever and fussiness. About 3 days ago, the child developed a cough and runny nose. Today, she had a temperature of 39 C at home. She has been receiving acetaminophen and ibuprofen for her symptoms. The medication helps with the fever for a few hours. She continues to eat and drink, but without much enthusiasm. She has frequent wet diapers. On exam, she is a well-nourished infant. She appears ill but not toxic. She appropriately resists the exam and is easily comforted in her Dad’s arms. A urinalysis came back negative. The above image of her left ear was obtained. The child has acute otitis media in her left ear. This is a classic presentation of acute otitis media (AOM). The tympanic membrane is bulging with marked erythema and pronounced vasculature. The bulging is due to increased pressure in the middle-ear space. This image is a beautiful example of AOM in that the bulging is not complete in the anterior-inferior pars tensa. In addition, it’s still possible to make out the lateral process of the malleus. It would be appropriate to start antibiotics on this patient. Compare the left ear with AOM to the normal right ear. The right ear has some erythema, but no bulging and the malleus is clearly visible.