Acute Otitis Media – December 19, 2024
A 5-year-old child presented to the emergency department (ED) with concern for “another ear infection.” His mother reports her son has had an upper respiratory illness for about a week. That morning, he complained his ear was bothering him, so she brought him in for evaluation. In the ED, he had a temperature of 39.5oC and his exam was remarkable for clear rhinorrhea and an occasional wheeze on auscultation. His WiscMed Wispr digital otoscope exam is shown.
Which of the following is true regarding this child’s finding?
- He has a right acute otitis media (AOM)
- He has a left AOM
- He has right bullous myringitis
- He has left bullous myringitis
Answer: A. He has a right acute otitis media (AOM)
This child’s Wispr exam demonstrates moderate to severe bulging of the tympanic membrane (TM) as evidenced by the presence of a classic “donut” sign, resulting when bulging progresses circumferentially around the umbo, the central point of attachment of the malleus to the TM. The presence of the donut sign indicates moderate to severe bulging and allows a confident diagnosis of AOM (AAP Guideline, see Seeing is Believing Part 2). What is less obvious is determining which TM is being viewed, left or right. Upon close inspection of the image, the tip of the lateral process can just barely be identified in the upper righthand aspect of the TM (roughly 3 o’clock). The lateral process is a useful landmark since its location points toward the side of the TM in question. In this case, the location is in the upper right side, thus this is the child’s right TM.
Compare this case of acute otitis media with a normal right eardrum.
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- AOM
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- Normal Right Ear
Bullous myringitis may be considered a more severe form of acute otitis media. In addition to the bulging found in AOM, bullous myringitis includes blistering on the TM.
WiscMed has created a visual guide to various ear conditions that may be found here.
Learning Points
- The donut sign indicates moderate to severe bulging of the tympanic membrane and allows a confident diagnosis of AOM.
- The lateral process of the malleus points toward the side of the TM in question.
- With moderate to severe bulging, the lateral process of the malleus may be difficult to identify. Knowledge of the expected position (upper left or upper right) will help locate this landmark.
Here is the complete video exam.
References
