CLINICAL CASES
CLINICAL CASES
Using the Wispr Digital Otoscope
Ear Pain in a 10-year-old
A 10-year-old presented to the Urgent Care clinic with complaints of ear pain for one day. She first felt mild pain in her left ear upon awakening. The pain had not worsened over the course of the day, but she developed a fever to 39.5oC which prompted the UC visit. Her triage vital signs were notable for a temperature of 40 °C. She appeared in mild distress. Her Wispr digital otoscope exam is shown.
According to the 2012 AAP Practice Guideline, which of the following is true regarding this child’s presentation?
A. She has severe acute otitis media (AOM) based on the duration of her symptoms.
B. She has severe AOM based on the appearance of her tympanic membrane (TM).
C. She has severe AOM based on her fever.
D. She has non-severe AOM.
C. She has severe AOM based on her fever.
Assessing the severity of acute otitis media (AOM) is an important step when determining treatment in children. While an AOM diagnosis is based on the physical findings, severity is primarily based on symptom duration, degree of pain, and height of fever. In the 3rd set of key action statements addressing treatment strategies, the AAP practice guideline notes moderate or severe otalgia or otalgia for at least 48 hours, or temperature 39 °C or higher are indicative of severe AOM, while mild otalgia for less than 48 hours or fever less than 39oC are indicative of non-severe AOM.
First, this child clearly has AOM based on the impressive bulging of her left TM. Compare this case’s image with a normal ear here.
Second, as she presented with mild pain lasting less than 48 hours, her fever of 40oC is the sign that is most consistent with severe AOM.
WiscMed has created a flyer as a simple reference for the diagnosis and treatment of AOM.
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