GOGETA
I'm Dr. GOGETA
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Q)2 yo child, mother reports he is pulling his LEFT ear, no fever vomiting, appetite good exam reveals cooperative kid,tympanic membrane red, no fluid on tympanogram..
what will u do?
a)PO amoxillin
b)gentamycin ear drops
c)refer to ENT
d)tylenol only
E) reassurance
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| saad_saad
Forum Newbie
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its otitis externa.. caused by pseudomonas............... treatment is penicillin ...so answer shud be A.......... i did that question in NBME forum 3 for step 1 .......... but i m not sure about answer
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| khorshid
Forum Guru
Topics: 32
Posts: 591
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I would go with tylenol(D), it seems like a viral otitis media probably ( my second choice would be reassurance), why would you say otitisexterna?!!!!
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| dr confused
Forum Senior
Topics: 67
Posts: 108
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E?
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| kpmle2
Forum Elite
Topics: 33
Posts: 297
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a)PO amoxillin ---red eardrum
2yo child has to be treated.
Initial observation for older child (>5) and nonsevere+ assured F/U.
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| Kamsi
Forum Guru
Topics: 103
Posts: 347
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Otitis media
Tx A Amoxicillin
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| DrAlex_76
Forum Junior
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so wat the answer ?
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| motorola
Forum Extremist
Topics: 66
Posts: 416
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id say amox. why shud a cooperative quiet child have red drum ? he is probably in the congestive stage of AOM. id give high dose amox for 10-14 days.
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| PGI2alpha
Forum Elite
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amox for sure...
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| jj123
Forum Newbie
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How about choice B? Since the child doesn't manifest any systemic symptoms, neither any prior URI history. I would think otitis externa would be more likely. Then gentamycin topical treatment is a better choice to kill pseudomonas. Amoxicillin is not adequate to cover gram negative rods. Can any one provide reasons to believe it is otitis media instead? Is ear pulling specific to diagnose OM?
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| arlete
Intern in 2009!!!!!
Topics: 30
Posts: 2,227
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Ear pulling may happen with OM AND otitis externa. But I think if the only finding is a red tympanic membrane, it's OM. I would give Tylenol, only.
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| sprint123
Forum Guru
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hey..OM is caused frequently by Strep. Pneumoniae..So, Amox would be better I suppose
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| arlete
Intern in 2009!!!!!
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Posts: 2,227
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There's a recent tendency in USA (following european researchers) to not give antibiotics to noncomplicated OM, only Tylenol for the pain. It's a self limited disease in most cases. It's proven that the outcomes giving and not giving antibiotic are pretty similar. Sometimes it's difficult to convince the parents, though.
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| arlete
Intern in 2009!!!!!
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If you want to read:
http://www.medscape.com/viewarticle/471768
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| hero
Forum Elite
Topics: 37
Posts: 460
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was searching current data related to redness of tympanic membrane in kids
found this 
http://www.aippg.net/forum/viewtopic.php?p=195002
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| hero
Forum Elite
Topics: 37
Posts: 460
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here is quite different opinion
http://findarticles.com/p/articles/mi_m0689/is_5_...
http://www.aafp.org/afp/20000401/2051.html
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| hero
Forum Elite
Topics: 37
Posts: 460
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GOGETA wrote:
tympanic membrane red, no fluid on tympanogram..
The diagnosis of AOM requires a history of the acute onset of symptoms and signs of middle-ear inflammation AND EFFUSION, the presence of a middle-ear effusion on physical examination, and signs of middle-ear inflammation.
Middle-ear effusion may be confirmed by poor tympanic membrane movement on pneumatic otoscopy, tympanogram, or the presence of either a bulging tympanic membrane, otorrhea, or an air fluid level on physical examination.
Fever and questionable signs of otalgia such as pulling on the ear are nonspecific and should not be used to make a diagnosis of AOM.
so, D
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