Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got the previous case on Emergency Department Management of Acute Pediatric Sickle Cell Disease Complications right.
Case Presentation: Management of Common Pediatric Ear Complaints in the Emergency Department
A 1-year-old girl presents to your ED with fever and fussiness…
- Her parents report that she has been crying more than normal over the past 2 days. They tell you she has decreased oral intake and that she is drooling more than normal. Her maximum temperature at home was 39.1°C. Her parents also report she has been sick recently with cough and congestion, though those symptoms have since improved.
- On examination, you note the patient is overall well-appearing but hesitant to examination, and she cries as you approach.
- What clinical findings would point you toward an ear-related underlying diagnosis?
Case Conclusion
Based on the history, you had a broad differential including meningitis, pneumonia, viral illness, peritonsillar abscess, and otitis media. With the assistance of a family hold, you were able to fully visualize both tympanic membranes. The tympanic membrane on the right was noted to be bulging with an opaque effusion. The remainder of the patient’s examination was reassuring, with no signs of respiratory distress or nuchal rigidity. The clinical findings pointed to AOM as the underlying diagnosis. After providing oral acetaminophen for fever management, the patient was smiling, and tolerated oral intake. She was discharged home with a course of oral amoxicillin, provided return-to-care criteria, and recommended to follow up with her pediatrician in 2 to 3 days.
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Last Updated on February 4, 2025
