ent - doc_heart

[ArchivalUser]

A 7 years old boy is brought to the emergency department by his parents because of the sudden onset of high fever and ear pain. The boy was well until the previous day when they noticed he had become irritable and kept pulling and rubbing his left ear. They tried giving him over-the-counter cold medication, which did not provide significant relief. The child has no significant medical problems and does not take any medication on a regular basis. On physical examination, the boy is in mild distress. His temperature is 38.9 C (102.2 F), pulse is 100/min, and respirations are 17/min. The right ear is examined first with an otoscope and it appears to be within normal limits. When the physician attempts to place the otoscope in the left ear, the child starts crying with pain. The tympanic membrane is red and bulging. Landmarks are lost and pneumatic compression reveals poor motility. Which of the following is most appropriate next step in the management?

A. Myringotomy and ventilation tubes
B. Oral amoxicillin
C. Oral loratadine
D. Topical neomycin plus polymyxin B plus hydrocortisone eardrops
E. Topical triethanolamine eardrops

[ArchivalUser]

B.

[ArchivalUser]

yes

[ArchivalUser]

The correct answer is B. This young patient has acute otitis media, and the most appropriate next step in his management is administration of oral amoxicillin, the treatment of choice for acute inflammation of the middle ear.
Myringotomy and ventilation tubes (choice A) are used in the treatment of recurrent otitis media and otitis media with effusion causing hearing loss or persisting longer than 3 months. It is not used in the treatment of acute otitis media.
Oral loratadine (choice C) is a long-acting, nonsedating antihistamine that may be used as part of the treatment approach to otitis media with effusion that is causing hearing loss or persists longer than 3 months.

Topical neomycin + polymyxin B + hydrocortisone eardrops (choice D) are used in the treatment of steroid responsive inflammatory conditions of the external ear canal in cases where a corticosteroid is indicated but a risk of bacterial infection exists. Examples of such inflammatory conditions are seborrheic dermatitis and psoriasis of the external ear canal.
Topical triethanolamine eardrops (choice E) emulsify or disperse excess or impacted earwax. They are used for removal of impacted cerumen 15 to 30 minutes before ear examination, otologic treatment, or audiometry. A perforated tympanic membrane or otitis media are considered a contraindication for the use of triethanolamine in the external ear canal.