A mother notices that her 13 month old child is fussy and tugging at his ears an

Question

A mother notices that her 13 month old child is fussy and tugging at his ears and refuses to eat breakfast. When she takes his temperature, it is 100° f. Although the child attends daycare his mother has kept him home and made an appointment with the child's pediatrician. In the Physicians office, his temperature is 100.2 , he is somewhat irritable, and he has a clear nasal drainage. His left tympanic membrane is erythematous and there is decreased motility on pneumatic otoscopy.

A. What risk factors are present that predispose this child to the development of acute otitis media?

B. Are is signs and symptoms typical of otitis media in a child of the age?
C. What are the most likely pathogens? What treatment would be indicated?
D. Later in the week, the mother notices that the child does not seem to hear as well as he did before developing the infection. Is this a common occurrence and should  the mother be concerned about the transient  hearing loss in a child of this age?

Explanation / Answer

A. Age less than 2 years, upper respiratory tract infection,lack of breastfeeding,genetics,recent use of antibiotics, exposure to tobacco smoke

B. Signs
1. Red or inflamed TM (could be caused by bacteria, viral infections, crying)
2. Presence of fluid behind TM
Symptoms
Fever, ear pulling, "pus" in ear canal, irritability, poor feeding, restlessness

C. 1. Streptococcus pneumoniae
2. Nontypeable H. infulenzae
3. M catarrahalis
Treatment
Acetaminophen, pain relievers

D. Generally child has otitis have hearing problem for short term. If there is a Tympanostomy tubes or middle hear damage have hearing loss of 40dB. Otherwise children not at risk for hearing loss.

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