Acute Otitis Media

An 8-year-old male arrives with his mother at the emergency department complaining of left ear pain. The pain started 4 days ago and has become worse. The child had ear infections as a toddler, but none recently. In addition to the ear pain, for the past several days he has also had seasonal allergy symptoms including watery eyes and a runny nose. Evaluation of the left ear reveals this image.

The child has acute otitis media (AOM) of the left ear. 

There is a significant bulging of the pars flaccida, loss of the malleus bony landmark, and erythema (redness). Given the history of worsening pain, along with this imaging, the child was placed on a course of antibiotics. Compare the left ear with the right ear: The right ear has some erythema, along with mild bulging of the pars flaccida. The malleus is still discernable. This ear alone would not have been an indication to start antibiotics. Here are the video exams of both ears. You can appreciate how well the Wispr otoscope is able to maneuver around the cerumen present in the canal. Here are links to two other cases featuring acute otitis media (AOM). AOM 1 and AOM 2.