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M. Gómez de Pablos Romero*, M. Sánchez Martín**
*Adjunto de Pediatría del Hospital Universitario Infanta Cristina.**Adjunto de Pediatría del Hospital Universitario La Paz
24. Earache: outpatient visit
Doctor: Good afternoon, what brings you here?
Mother: Good afternoon Dr. Collins. I’ve brought my son because he has been complaining of ear pain since this morning.
Doctor: Ok, Jimmy, how old are you now? Which ear is hurting?
Jimmy: I’m 4 years old already. It’s my right ear.
Doctor: What a big boy! Tell me, have you seen any ear discharge? Has he had any other symptoms? Fever? Cough? Runny nose? Has he been in contact with someone with coronavirus?
Mother: We haven’t seen any ear discharge. He’s been coughing and with a runny nose for the last 3 days, and yesterday he had 37.8ºC. He hasn’t had any other symptoms. We’ve not been in contact with anyone with coronavirus that we know of.
Doctor: Very well Jimmy, let’s take a look at you.
PHYSICAL EXAMINATION
Good general condition. Well-nourished and hydrated. Capillary refill time: 2 seconds. No difficulty breathing. Normal cardiopulmonary auscultation. HEENT: head ears nose and throat examination. hyperemic oropharynx. Normal left tympanic membrane. Erythema and bulging of the right tympanic membrane. No otorrhea. Small, rubbery, mobile and nontender laterocervical bilateral adenopathies. Normal abdomen.
Doctor: It seems Jimmy has acute otitis media. Since the symptoms are not severe, he can be treated initially with ibuprofen every 8 hours for two days.
Mother: Doesn’t he need antibiotics?
Doctor: Not at this moment. He hasn’t had high fever or ear drainage, and only one ear is affected. Most of the acute otitis media in children above 2 years old resolve spontaneously. However, if he gets worse or ear discharge appears or you notice that his ear protrudes or that the area behind his ear turns red and swollen, you should bring him again to take another look at him.
Mother: Alright. What would it mean if the area behind his ear turned red and swollen? Should I worry about it?
Doctor: It could be a sign of mastoiditis, a suppurative infection of the mastoid air cells in the skull, which would mean that the infection has spread. This however, is not a very frequent complication, so there’s no need to worry if he responds well to ibuprofen.
Mother: OK. Thank you Dr. Collins.
Doctor:There’s one more thing. You know that we are in a COVID-19 pandemic situation. Therefore, since he’s had low-grade fever and coughing, we need to perform a PCR test for coronavirus and the whole family should be isolated at home until we have a result. So please wait outside until the nurse calls you and I will get back in touch in 2 days.
KEY WORDS:
Earache/ ear pain: otalgia.
Ear discharge/ ear drainage/ otorrhea: supuración del oído, otorrea.
Erythema of the tympanic membrane: eritema/hiperemia de la membrana timpánica.
Bulging of the tympanic membrane: abombamiento de la membrana timpánica.
Acute otitis media: otitis media aguda.
To protrude: protruir.
Mastoid air cells: celdillas mastoideas.
Skull: cráneo.
COVID-19 pandemic situation: situación de pandemia COVID-19.
Low-grade fever: febrícula.
PCR test for coronavirus: test de PCR de coronavirus.
