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Wednesday, April 1, 2020

MDM - Acute Otitis Media

[##-month/year-old male/female] with [ear pain/fever] with history and exam consistent with likely acute otitis media of the [right/left/bilateral ear(s)].

Initial considerations in this patient included acute otitis media, otitis externa, mastoiditis, ear foreign body, tympanic membrane rupture, pneumonia, and other upper respiratory infections (URI) among others.

Patient presented with complaint of [fever/fussiness/ear pain] and was noted to have evidence of erythema, [bulging,] and effusion on examination of the [right/left] tympanic membrane consistent with otitis media.  [Visualization of the tympanic membrane incomplete due to cerumen in the external auditory canal, but no evidence of significant erythema or bulging of the visualized portion.]  Patient noted to have associated fever, ear pain, and [upper respiratory symptoms] consistent with otitis media.  No abnormal lung sounds, sputum production, [abnormal findings on chest x-ray,] or other findings suggestive of pneumonia noted.  No evidence of debris or swelling of the external auditory canal suggestive of otitis externa noted on exam.  No evidence of perforation of the tympanic membrane noted on exam.

We discussed [watch and wait prescription of antibiotics/discharge with antibiotics] with the patient’s [mother/father/parents] who demonstrated understanding and agreement with this plan.  Prior to discharge, we discussed return precautions, specifically for evidence of worsening infection, and follow up with primary care doctor within [2-3 days/1 week] for further evaluation, and the patient’s [mother/father/parents] demonstrated understanding and agreement with this plan.

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