Bilateral AOM

An 8-year-old male with a history of ADHD presents to the emergency department (ED) at 2 a.m. with his mother. She reports that he has a history of ear infections. He’s had mild viral symptoms for the past several days. Last night he began to complain of left ear pain. The mother provided Tylenol and put the child to bed. He woke up with worsening left ear pain resulting in the ED trip. The child is afebrile. He is holding his left ear but is otherwise high-energy and well-appearing. The following image of his left ear is obtained with the Wispr digital otoscope. What is the next course of action?

Left Ear

The child has acute otitis media (AOM) in his left ear. The key features include bulging of the tympanic membrane (TM, ear drum), erythema, and loss of the middle ear bony landmarks. In addition, examination of the child’s right ear also reveals mild acute otitis media. Note the difference between the right and left ear. In the right ear (below) the malleus bone is still discernable as the bulging is not yet severe.

 

  

Right Ear

WiscMed has created a guide to evaluate and treat acute otitis media based on American Association of Pediatrics (AAP) guidelines. This guide may be found here. Reviewing the guidelines, the child’s left ear qualifies as severe AOM and should be treated with antibiotics. 

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