What are signs and symptoms
of an ear infection?
Well, first it's otalgia - it hurts.
and this is worse when children are lying down.
Young children may pull or tug at their ear,
sometimes they'll hit the side of their
face to indicate that it's hurting
Children typically have difficulty sleeping
and this is sort of a classic presentation,
the parents will say, "you know my child woke up at 2 o'
clock in the morning and they just couldn't stop screaming
and this is a good indicator that
the child might have an ear infection
These children are sometimes inconsolable.
They're irritable, they're crying -
this is a very painful condition.
The children may have difficulty
hearing or responding to sounds,
and this has to do with the
infection in the middle ear.
They may have a loss of balance
that may end up falling.
and this has to do with the decreased proprioception
that happens when that fluid is in the middle ear space.
And the children will have a fever,
usually 38 degrees or higher.
you might not see the fever if
the child is on antipyretics
How do we examine a child to see
if they have an ear infection?
Well you use an otoscope, and this is a medical
device that's used to look into the ears.
It's basicaly a glorified funnelled
flashlight with magnification
The clinician can assess the ear canal and the eardrum
to screen for only this during regular well checks
and also to diagnose ear symptoms
including ear infections.
When you put the scope in the ear,
you look through the ear canal
and your angle is to see the
tympanic membrane or the eardrum.
You're checking to see if there's
any bulging on the eardrum
and signs and symptoms of otitis media
you'll see moderate to severe bulging
The child may also have a new set of otorrhea which is a
fluid in the ear canal, not caused by otitis externa
We'll cover that in the next section.
Also, there may be mild bulging associated
with recent onset of ear pain, or erythema
Here's an example on the right
of a normal tympanic membrane .
It's beautiful, it's grey, it's translucent.
you can see the bones, you can see the cone of light
reflecting and you can see all of the landmarks
This is what a normal eardrum should look like.
In the setting of otitis media, you'll see
the next, the bulging tympanic membrane
It is red, it's inflamed, it's opaque - you can't see
the bony landmarks and the cone of light is distorted.
On exam, the clinician will also note
post-auricular and cervical lymph node enlargement
and these are the lymph nodes responsible
for filtering ear infections.
The diagnosis is established by
compnents of the physical exam,
combined with the presence
of the patient's symptoms.