Management of Common Pediatric Ear Complaints in the Emergency Department (Infectious Disease CME and Pharmacology CME)

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Delivery Method:	Online
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Publication Date: December 2024 (Volume 21, Number 12)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 12/01/2027.

Specialty CME Credits:Included as part of the 4 credits, this CME activity is eligible for 3 Infectious Disease credits and 1 Pharmacology credits, subject to your state and institutional approval.

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Abstract

The clinical presentation for ear complaints can often overlap with other common pediatric conditions. As such, the differential diagnosis for ear complaints is broad, warranting a thorough history and targeted physical examination. Optimizing the approach for a definitive ear examination is essential when evaluating a pediatric patient with an ear concern. A systematic approach will improve the accuracy of diagnoses and the appropriateness of management. This issue provides an evidence-based approach to the diagnosis, workup, and management of common ear complaints in pediatric patients.

Case Presentations

A 1-year-old girl presents to your ED with fever and fussiness...

• Her parents report that she has been crying more than normal over the past 2 days. They tell you she has decreased oral intake and that she is drooling more than normal. Her maximum temperature at home was 39.1°C. Her parents also report she has been sick recently with cough and congestion, though those symptoms have since improved.
• On examination, you note the patient is overall well-appearing but hesitant to examination, and she cries as you approach.
• What clinical findings would point you toward an ear-related underlying diagnosis?

A 2-year-old boy is brought in by his parents for concern for prolonged fever…

• The patient has had a fever for the past 7 days, despite currently being treated with amoxicillin for an ear infection. During this time, the patient has been more fussy than normal, with decreased oral intake. His parents deny any rashes or skin changes but do report that his left ear appears to be sticking out more than normal. They tell you he has not had any cough, congestion, vomiting, or diarrhea.
• The boy is febrile and tachycardic, but his vital signs are otherwise stable. You find the patient to appear uncomfortable on examination and difficult to console.
• How should you approach the workup?

An EMS crew brings a 5-year-old boy to your ED for complaints of hearing things...

• The family reports that the boy woke up this morning and started complaining of hearing noises that the family cannot hear. He has no history of similar concerns, and the family denies access to medications in their house. The parents report that their son has not been sick recently.
• On evaluation, you note the patient is holding his head and seems irritated. He is afebrile with no signs of respiratory distress. There is no report to indicate ingestion or intoxication.
• How should you approach the management of this patient?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.