October week 2

Otitis Media


1. AAP Clinical Practive Guideline: Otitis Media with Effusion
2. AAP Clinical Practive Guideline: Acute Otitis Media

Case 1

You are seeing a 12 month old in your office for an acute visit. Mom reports she has been more irritable lately and has been pulling at her right ear.

Describe your exam technique. 
Define AOM vs OME.
You note redness, fluid, and bulging of the TM. How do you treat? 
If you note only middle ear effusion without redness and normal pneumatic otoscopy, what would be your plan?
If you decide to treat with antibiotics, what organisms are you targeting and what agent would you start with? 
The child returns 3 days later with same symptoms, now with fever to 39.5 C, exam unchanged. How do you proceed? 
What are interventions that may prevent AOM?

Case 2

You are seeing a 2 yo boy for a well visit in your office. Mom reports that he has about 10 words that only family can understand, and is not putting 2 words together. You note on exam that his right ear has an air-fluid level.

What is your next step? 
If hearing loss is found and the effusion persists at next visit, what is your next step?