Otitis Media

An otherwise healthy 17-month-old boy had a cold accompanied by two days of rhinorrhea, cough, and fever (temperature of up to 38.8°C). On day 5, he became fussy and woke up crying several times during the night. The following day he was afebrile, and a physical examination was normal except for findings of a slightly red left tympanic membrane with no middle-ear fluid and a bulging right tympanic membrane with white fluid behind it, obscuring the umbo. How should he be treated? Foreword This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage An otherwise healthy 17-month-old boy had a cold accompanied by two days of rhinorrhea, cough, and fever (temperature of up to 38.8°C [102°F]). On day 5 he became fussy and woke up crying multiple times during the night. The following day he was afebrile, and a physical examination was normal except for findings of slight redness of the left tympanic membrane with no middle-ear fluid and a bulging right tympanic membrane with white fluid behind it obscuring the umbo. How should this child be treated? The Clinical Problem Otitis media, or inflammation of the middle ear, is diagnosed more . . .