Question

An otherwise healthy 2 year old male returns for follow-up of bilateral ear effusions. Several months ago, the patient completed a course of amoxicillin for bilateral acute otitis media, but later follow up revealed persistent effusions. At his last visit, audiometry revealed only slight hearing loss bilaterally (<20 db). Today, his mother states that she does feel that he doesn't seem to hear as well as his siblings, though he has been afebrile and has no other symptoms. Physical exam reveals nonerythematous, immobile tympanic membranes with persistent effusions bilaterally. Repeat audiometry reveals a bilateral hearing deficit of 42 decibels. What is the most appropriate next step in the management of this patient?

A. Chlorpheniramine and pseudophedrine
B. Prednisolone
C. Referral for tympanostomy tube placement
D. Cefdinir
E. Follow up in three months

Answer 1

The most suitable management step for a 2 year old with bilateral ear effusions and significant hearing loss is C. Referral for tympanostomy tube placement, to drain the fluid and restore auditory function.

Step-by-step explanation:

In the case of a 2 year old with bilateral ear effusions and a subsequent diagnosis of significant hearing loss (42 decibels), the most appropriate next step in management would be C. Referral for tympanostomy tube placement. Given the persistence of the fluid behind the tympanic membranes after a course of antibiotics and the fact that audiometry has revealed worsening hearing loss, it is crucial to address the effusions to prevent further hearing impairment and possible speech or developmental delays. Use of medications like antihistamines, decongestants, or antibiotics (options A, B, and D) have not been shown to be effective for otitis media with effusion, and simply following up in three months (option E) may delay necessary treatment, allowing the condition to potentially worsen or cause complications such as chronic otitis media.

The condition of otitis media with effusion (OME), which is marked by non-infected fluid accumulation in the middle ear, can affect a child's auditory function and development. Tympanostomy tube placement can facilitate the drainage of this fluid and restore middle ear function, thus improving hearing and preventing further complications associated with chronic ear effusions and hearing loss.