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| Expert Case I: | |
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Child aged 9 months Being seen for well-child checkup Left TM dull, bulging, No symptoms of AOM or URI |
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| Expert's Comments: This child has a bulging, erythematous tympanic membrane consistent with the diagnosis of AOM. However, there are no symptoms, at least that the parent has recognized. Children with this problem are commonly seen during the winter months. They may or may not have had a URI within the weeks preceeding the examination. A tympanogram will usually be abnormal. Several studies have investigated the possibility of withholding antibiotics in a group of children whom we define as having "mild" AOM. These children usually have minimal symptoms accompanied by a mildly inflamed non-bulging, but erythematous TM and fluid-filled middle ear. Experience in some European countries and some research results indicate that many children with mild AOM will improve by themselves without antibiotic. At present we counsel the parent on the appearance of the TM and give the parent the option of simply observing the child for the development of symptoms. If symptoms develop, the parent can call the office for a prescription. If the parent does not have access to the physician by telephone, then we can write an antibiotic prescription which the parent can fill during the next several days if the child develops AOM-related symptoms. If the physician is uncomfortable about writing a prescription to be filled at a later date, the prescription can be dated and time-limited. As an alternative, in lieu of an antibiotic prescription, the parent is given the provider's beeper number, so contact can be easily made if the child should develop symptoms. |
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