The toddler with recurrent ear infections

SB is a 16-month-old Native American boy who presents to your office with a history of fever, rhinorrhea, and tugging at his ear. He is accompanied by his mother, who is 12 weeks pregnant, and his 3-year-old brother, who also seems to have cold symptoms. You talk with SB’s mother about his presenting symptoms and history and complete a detailed physical exam.

SB started with a slight cough and runny nose 4 days ago. The rhinorrhea started with a small amount of clear discharge but has increased over the past 48 hours. SB had been active and playful despite his symptoms until last night when his fever spiked to 102.2 degrees F (39.9 degrees C). His mother reports he was up most of the night crying and wanting to be held. He had one ear infection at 8 months of age and his mother is concerned that he may have another one because he is intermittently tugging at his right ear, acting as if it hurts. Ibuprofen has helped some with the fever and pain. Today SB has been drinking well and has had several wet diapers, but he is not interested in eating. He has had no vomiting, but his stools have been loose for the last 2 days.

Questions.

1. Identify the distinguishing signs and symptoms of acute otitis media (AOM) and otitis media with effusion (OME).

2. Apply the guidelines for management of acute otitis media and otitis media with effusion.

3. Recognize the risk factors associated with development of acute otitis media.

4. Identify when patients need to be referred to an otolaryngologist for treatment.