CLINICAL CASES
CLINICAL CASES
Using the Wispr Digital Otoscope
Autistic Child with history of AOM
A three-year-old child with autism and a history of speech delay presented to her pediatrician’s office for a well-child visit. Her recent medical history is significant for acute otitis media (AOM) diagnosed one month earlier, for which she was treated with antibiotics. Mom reported no new complaints of congestion, cough, or fever. The child strongly resisted pneumatic otoscopy attempts, and tympanometry was not readily available. Her Wispr digital otoscope exam is attached.
Which of the following is true regarding this child’s condition?
A. It can only be diagnosed with pneumatic otoscopy or tympanometry
B. She should be treated with a course of antibiotics
C. It often resolves with antihistamines or topical corticosteroids
D. She should be reassessed in two months to ensure resolution
Answer: D. She should be reassessed in two months to ensure resolution
This young child’s Wispr digital otoscope exam demonstrates an otitis media with effusion (OME) as evidenced by a visible middle ear effusion (MEE) air-fluid interface combined with a lack of significant tympanic membrane (TM) bulging. The malleus is clearly visible. Also notable are the translucency of the TM and normal cone of light—further evidence that her TM is not inflamed and the MEE is not infected.
OME is common in children due to their propensity for upper respiratory infections. While most OMEs resolve spontaneously within three months, an estimated 25% persist and may place a child at risk for hearing loss, speech delay, behavioral problems, and school performance. This is especially true in children with risk factors such as Down syndrome, cleft palate, and developmental delay. The most recent multidisciplinary Clinical Practice Guideline provides helpful guidance on diagnosis, management, and referral recommendations. Antibiotics, antihistamines, and corticosteroids do not help resolve OME. However, given the child’s risk factors, she should be reassessed for resolution in about two months. If the OME persists, referral for hearing assessment and potential tympanostomy tube placement is indicated.
Of note are the key action statements regarding the use of pneumatic otoscopy, which is strongly recommended to document the presence of MEE and diagnose OME. While traditional otoscopy purists may disagree, it is the author’s opinion that adequate visualization of the TM with digital otoscopy can frequently supplant the need for this uncomfortable and (realistically) rarely utilized procedure. When fluid is visualized on the otoscope screen, pneumatic otoscopy adds no value, and the child can avoid a procedure that very few clinicians are skilled at performing or teaching. Admittedly, the TM at times may be opaque or sclerotic, obscuring the presence of a MEE. In these instances, obtaining tympanometry in line with the guidelines would be beneficial. Last published in 2016, analyzing data from well before the advent of digital otoscopy, an update to assess technological advancements would be welcomed by all who care for children.
Reference:
Rosenfeld, R.M., Shin, J.J., Schwartz, S.R., Coggins, R., Gagnon, L., Hackell, J.M., Hoelting, D., Hunter, L.L., Kummer, A.W., Payne, S.C., Poe, D.S., Veling, M., Vila, P.M., Walsh, S.A. and Corrigan, M.D. (2016), Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngology–Head and Neck Surgery, 154: S1-S41. https://doi.org/10.1177/0194599815623467
