Young Child with Mild Ear Pain: Part 1

A 3-year-old male presented with a one-day history of left-sided ear pain. He remained afebrile and appeared well overall.  His father felt the pain was likely mild and denied any complaints relative to his right ear. His Wispr digital otoscope exam image is attached below.

Based on his presentation, which of the following is the most appropriate management for this child?

A. Treat immediately with high-dose amoxicillin for 10 days.
B. Recommend supportive treatment with ibuprofen or acetaminophen as needed.
C. Provide a Safety Net Antibiotic Prescription to be used if symptoms worsen over the subsequent 48 hours.
D. B & C

On initial evaluation, the child was diagnosed with acute otitis media (AOM) of the left ear based on the presence of moderate bulging and a purulent-appearing middle ear effusion (MEE). Given the unilateral presentation and absence of severe symptoms, a watchful waiting approach was offered under clinical guidelines. The patient’s ear pain was effectively managed with ibuprofen over the subsequent four days. Daily Wispr otoscopic images demonstrated progressive improvement in the appearance of the tympanic membrane (TM) with a decrease in bulging and the purulent MEE transitioning to a serous (images 1-4). By Day 5, one could confidently make the diagnosis of otitis media with effusion (OME) based on the lack of bulging and a serous MEE.

WiscMed has created a visual guide to ear conditions that may be found here.

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