AOM in child

Age: ‍ ‍monthsyears old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍rightleft ‍ear painfeverirritability

Symptoms include:

‍ear pain

‍impaired hearing

‍tinnitus

‍ear discharge

‍fever, up to ‍°, over ‍ ‍hoursdays

‍irritability

‍pulling at ears

‍loss of appetite

‍sleep disturbances



Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍exposure to secondhand smoke

‍daycare attendance

no history of: ‍otitis media, ‍upper respiratory infections, ‍allergies, ‍adenoidal hypertrophy

no use of: ‍antibiotics





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Head: fontanelles ‍soft, ‍normocephalic

Eyes: conjunctiva/sclera ‍normalinjection, lids/lashes ‍normalerythema, ‍PERRL, extraocular movements ‍intact, red reflex ‍present, corneal light reflex ‍symmetrical, fix and follow test ‍intact

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Nose: ‍clear, ‍nasal flaring, discharge ‍clear, ‍

Throat: ‍normal, ‍palate intact, ‍redness

Neck: ‍normal, ‍lymphadenopathy, ‍nuchal rigidity, ‍torticollis, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍normal inspection, ‍joints ‍normal, ‍limited ROM, ‍normal spine, Barlow ‍negative, Ortolani ‍negative, ‍normal pulses, cap refill ‍< 3> 3 sec

Skin: ‍rashlesions on ‍





ASSESSMENT:

‍Acute otitis media ‍likelysuspectedpossible

DDx: acute otitis media, otitis media with effusion, external otitis, foreign body in ear, eustachian tube dysfunction, upper respiratory infection, sinusitis, pharyngitis, dental abscess, mastoiditis, adenoid hypertrophy, tonsillitis, temporomandibular joint disorders, herpes zoster oticus, influenza, COVID-19





PLAN:

Investigations:

- Blood work: ‍CBC, ‍CRP

- Audiogram

Treatments:

- ‍Analgesics

- ‍Ibuprofen

- ‍Antibiotics

- ‍Decongestants

- ‍Nasal Steroids

Further care:

- Referral to otolaryngologist if recurrent episodes

- Follow-up in ‍ ‍daysweeks

- Return if symptoms do not improve after 72 hours or if worsen