A 6 year-old boy comes in with acute, unilateral L ear pain and a report that the left side sounds "like he's underwater" that has been worsening for two days. He has been afebrile, has had mild rhinorrhea and no cough, and pain has been poorly managed with motrin. On exam, breath sounds are normal bilaterally, his throat is erythematous without tonsilar swelling, cobblestone appearance to the posterior oropharynx, there is no tonsilar discharge, effusion or evidence of abscess. There is no significant cervical or occipital lymphadenopathy, and he admits to mild sinus tenderness upon palpation. His R TM is clear with a cone of light, but the L TM is mildly dull without the appearance of fluid. He has mild L-sided tenderness from T1-4. A rapid strep is negative, CBC is WNL, CRP has trace elevation. You diagnose the patient with a non-bacterial AOM and possible viral URI. You release his thoracic outlet, which is tight on the left. You do effleurage to the sinuses bilaterally, and use Galbreath maneuvers to open up his eustacian tubes.
- Foundations - Chapter 22 “General Pediatrics”
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