Mary Beth Howard, MD, Children’s National Medical Center with Karie Button, MD, Children’s National Medical Center

CC: 5 wk old M with b/l ear drainage and fussiness

HPI: 5 week old ex FT boy presenting with 1 day of bilateral ear drainage. Father reports it started the day PTA. Discharge is yellow/clear. Coming from both ears. Uses q-tips and cotton balls to clean ears. Father unable to tell if his hearing is different. More fussy than usual. Given 2.5mlL ibuprofen 6 hrs PTA for fussiness. No documented fevers. Decreased PO intake day of PTA, normal UOP. Diffuse rash over body for the past week, worst on face/scalp with some spread to arms and legs, no changes recently.

ROS:

Constitutional: Fussiness, no fever.

Skin: Rash on whole body for past week.

Eye: No redness, no discharge.

HEENT: B/l ear drainage, no nasal congestion.

Respiratory: No SOB, cough, stridor or apnea.

Cardiovascular: No nursing cyanosis or diaphoresis

Gastrointestinal: No vomiting, no diarrhea

Neurologic: no altered level of consciousness

PMH: Born at 40 weeks, NSVD. Normal pregnancy. No history of maternal illness or infection during pregnancy. Growing and developing normally since then, no history of infections.

Meds: none

All: none

PSH: none

FHx: No FH history of immunologic disorders

SHx: Lives with parents and 4 older siblings.

Exam:

VS: T 37.2 HR 120 BP 99/55 RR 32 SpO2 98%

General: Fussy, intermittently consolable in mother’s arms

HEENT:  AFOF, AT/NC. Bilateral ears with dried, crusting, yellow drainage (see photo below) R>L with mild erythematous plaque on Right pinna. Bilateral swelling of external auditory canal with difficulty visualizing TMs secondary to swelling and debris. No obvious tenderness on palpation or traction of ear. No mastoid tenderness. No warmth. No ear proptosis.

Eyes: conjunctiva clear, PERRLA, EOMI. Nose: patent and clear b/l. Mouth: palate intact, moist mucus membranes, good suck.

Cardiovascular: RRR, no m/r/g. Femoral pulses 2+

Respiratory: Normal WOB, lungs CTAB

Abdomen: Soft, NT/ND, NABS. Umbilicus without erythema or drainage

GU: Normal external male genitalia, uncircumcised, testes descended b/l

Skin: No bruising. Neonatal acne on face, seborrheic dermatitis on scalp and eye brows

MSK: Hips without clicks or clunks, moving all extremities equally.

Neuro: Normal suck, grasp. Symmetric Moro

A BCx and CBC are obtained:

WBC 13.09 (12% neutrophils, 61% lymphocytes, 9% eosinophils, 1% monocytes) 

Hgb 12.6 Hct 53.2 Plts 263

ENT evaluated the patient. Ability to visualize TM limited secondary to external auditory canal swelling, but visualized portion of TM intact. Felt that exam findings consistent with bilateral otitis externa in the setting of possible bilateral AOM. While swelling of external auditory canal limited full view of TM, rupture secondary to inflammation could not be ruled out. Given age, recommended patient be treated with PO Augmentin and topical Ciprodex.

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