Otitis Media With Effusion

A mother brought her 5-year-old son to the Urgent Care for fever and ear pain. She reported the child had symptoms including a fever of 101 F, cough, and runny nose for the previous 3 days. Earlier in the day, the child began to complain of left ear pain. He had completed a course of antibiotics for an ear infection one month prior to this illness but otherwise had been healthy. On examination, he had copious clear rhinorrhea and mild ronchi breath sounds. His Wispr Digital Otoscope is attached below.

Which of the following is the appropriate management?

A. Prescribe a course of amoxicillin
B. Prescribe a course of amoxicillin/clavulanate
C. Prescribe a course of cefdnir
D. Do not prescribe antibiotics

The child has otitis media with effusion (OME) and should not receive a prescription for antibiotics to treat a recurrent acute otitis media (AOM). Both OME and AOM are notable for middle ear effusion (MEE), or fluid behind the eardrum. The most sensitive physical finding distinguishing the two is bulging--AOM will demonstrate bulging, which is a sign of inflammation associated with the MEE being infected by bacteria. If present in OME, bulging is typically mild and not associated with other (notably less sensitive) signs of inflammation such as intense erythema. Compare the OME and AOM images below. It is easy to confuse OME with AOM if you do not obtain a good view of the eardrum.

Otitis Media with Effusion (OME)

Acute Otitis Media (AOM)