Chronic Otitis Media with Effusion – July 25, 2024
A 3-year-old child presented to the emergency department (ED) with concern for a fever of 101.3oF at home. His mother reports he had been acting fussy but is otherwise at his baseline of “chronic nasal congestion.” His medical history is significant for speech delay, snoring, and occasional sleep apneic events. He has had a few ear infections in his lifetime, but not recurrent. His last ear infection occurred approximately three months ago and was treated with amoxicillin. During the physical exam, he was found to be well-appearing overall. He has boggy nasal mucosa and 4+ tonsils that are non-erythematous and without exudates. His Wispr digital otoscopic exam is shown.
Which of the following is the most appropriate course of action?
- Treat with high dose amoxicillin
- Treat with acetaminophen
- Referral to an otolaryngologist (ENT) specialist
- Reassurance
Answer: C. Referral to an otolaryngologist (ENT) specialist
The child, in this case, has an amber-colored middle ear effusion (MEE). There is no evidence of infection–no bulging and the malleus landmarks are easily appreciated—thus he may be diagnosed with otitis media with effusion (OME). The amber color is classically observed in MEE that are persistent, thus one could further define his condition as chronic otitis media with effusion (COME). Recurrent acute otitis media (AOM), adenoid hypertrophy, and young age with frequent upper respiratory infections predispose children to COME. This child does not have a particularly high number of AOM diagnoses, but his snoring and occasional sleep apnea episodes suggest upper airway obstruction is likely. Furthermore, the persistence of MEE may impact hearing and result in speech delay, therefore referrals to ENT and Audiology are warranted.
The child was referred to ENT where his audiology exam was remarkable for conductive hearing deficit. He was scheduled to have tonsillectomy and adenoidectomy as well as tympanostomy tube placement the following week.
WiscMed has produced a visual guide to ear conditions that may be found here.
Here is the complete video exam.
