Case Study A 7-month-old presents to the clinic in with complaints of being fussy and having a fever. Mom says he didn’t sleep well last night and woke up frequently. He has had a cold for a few days but has been doing OK. Last night his temperature was 101.2 and he was given ibuprofen. He drank some of his bottles of formula but didn’t eat anything else this morning. He had a wet diaper this morning. He has had an unremarkable past medical history and was a vaginal delivery at 40 weeks with no complications. The temperature now is 101.8. The left tympanic membrane is erythematous and injected with yellow pus behind the membrane. The light reflex is splayed, and mobility is decreased. The right tympanic membrane is pearly gray and mobile with a short light reflex. The neck is supple with anterior cervical adenopathy. Purulent yellow discharge is noted from his nose. Pharynx is mildly erythematous without exudate. Lungs are clear to auscultation. The rest of the exam is normal. a. What other lab/diagnostic testing would you order? b. What is your differential? c. What is your management plan? d. What are the differences between acute, persistent, and recurrent otitis media? e. If the exam indicated cerumen impacting the canals how would you assess/manage the patient differently? f. What factors predispose to the development of ear infections? g. What are the most common presenting signs and symptoms of an ear infection in infants, older children, and adolescents? h. How do the treatment considerations differ between acute, persistent, and recurrent ear infections? i. What are the complications of OM?
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