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You are seeing an 8 month old child with viral URI symptoms and pulling at the left ear. The child has not had any fever, is fully immunized, and is well appearing and playful. The right ear is translucent. The left ear is erythematous, with no bulging, perforation, or air-fluid level. Mobility is normal on pneumatic otoscopy. The child had one previous ear infection diagnosed at age 5 months.
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May 22, 2018 at 10:21 am
D. Reassure the parent and give return precautions. For a diagnosis of otitis media to be made, there must be evidence of an effusion (eg poor mobility, air fluid level, bulging tympanic membrane); redness is not sufficient. If there had been an otitis media, a child age 6-23 months with unilateral otitis and no severe symptoms or otorrhea could be treated with the observation option +/- a backup prescription vs. close follow-up.