Bilateral AOM – May 30, 2024
A six-month-old male is brought into the pediatrician’s office with concern for fever and fussiness. The child has been generally healthy and is fully immunized. The mother reports that the day-care attending child developed a cough and runny nose 3 days ago. Yesterday, he developed a fever of 101.5 F. The mother has been pushing fluids and providing acetaminophen. On physical exam, the child appears ill without being toxic. He appropriately resists the exam. His mucous membranes are moist, and his capillary refill is less than a second. His temperature is 102 F. The following image of his left tympanic membrane (TM, “ear drum”) is obtained with the WiscMed Wispr digital otoscope.
What is the next step in management?
- The child should be admitted to the hospital for fluids and IV antibiotics.
- The child should be discharged on oral antibiotics with careful return instructions.
- The mother should be reassured and continue her home treatment.
- An urgent consultation with otolaryngology (ENT) for ventilation (ear tubes) should be placed.
Answer 2. The child should be placed on oral antibiotics with careful return instructions.
The child has acute otitis media (AOM). The eardrum is severely bulging, there is erythema (redness) and loss of bony landmarks. This would be classified as severe AOM. In fact, the child has AOM in both ears. Compare these images of AOM with a normal ear.
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- Left AOM
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- Right AOM
American Academy of Pediatrics (AAP) treatment guidelines are for initiating antibiotics for severe AOM. Since the child is well-hydrated and non-toxic, there is no indication for hospital admission. The child does not have a history of ear infections, so ear tubes are not indicated now.
WiscMed has created a visual diagnosis of ear conditions, which may be found here.
Here are both the left and right ear videos.
Left Ear AOM Video
Right Ear AOM Video
