A 2 Year Old Child With A Fever

A 2 year old female child is brought to the clinic by her mother with a complain of fever for 2 days. The mother reports that the child has been tired, and not playing with her toys or watching TV as she usually does. The fever was gradual in onset , intermittent in character and high grade. The child has no appetite and is refusing to eat anything. she has been pulling on her ears and has difficulty swallowing and sleeping for the past 2 days. Her past history is unremarkable and she is vaccinated up to date. Her developmental history is also appropriate for her age.
On physical Examination she had a temperature of 101 F and was very irritable. Her Respiratory rate was 42 breaths / minute and the lungs were clear on auscultation. She had no rash. On otoscopic examination following was seen:

The above picture shows a bulging , erythematous tympanic membrane, with indistinct landmarks and a displacement of the light reflex.

Diagnosis : Acute Otitis Media

Case Discussion:
Acute otitis media is a n infection of the middle ear that may be caused by bacteria or viruses and usually accompanies an upper respiratory tract infection. It can occur at any age but is most commonly seen in children 3 months to 3 years of age.
The signs and symptoms include:

• fever
• nausea, vomiting or diarrhea as non specific symptoms in infants.
• Irritability and refusal to eat.
• pulling at ear.
• Otoscopic examination can show a bulging, erythematous tympanic membrane with indistinct land marks and dispalcement of the light reflex. 
• Air insufflation (pneumatic otoscopy) shows poor mobility of the tympanic membrane. 

Treatment: is with analgesics for pain, antipyretics for fever and antibiotics for early resolution and preventing spread of infection. In some cases myringotomy may be required.