Rosh Pediatrics Practice Exam

What is the most appropriate management of a 4-year-old child with a small tear in the tympanic membrane?

1. AAdminister amoxicillin for 10 days

2. BAdminister polymyxin B-neomycin-hydrocortisone otic suspension

3. CAdmit the child and begin intravenous antibiotics

4. DKeep the ear clean and dry, then follow up with otolaryngology

The correct answer is: DKeep the ear clean and dry, then follow up with otolaryngology

In the case of a 4-year-old child with a small tear in the tympanic membrane, the most appropriate management focuses on allowing the ear to heal naturally while preventing complications. Keeping the ear clean and dry is crucial because moisture can increase the risk of infection. The tympanic membrane has the ability to heal on its own, especially in small perforations, so it's important to monitor the situation closely. Following up with otolaryngology ensures that an specialist evaluates the healing process and intervenes if any complications arise or if the perforation does not heal appropriately. Other management options, like administering antibiotics, are typically reserved for cases with signs of an active ear infection or significant symptoms. While polypexin B-neomycin-hydrocortisone otic suspension may be useful in certain outer ear infections, it is not indicated for a simple perforation of the tympanic membrane without any infection present. Similarly, intravenous antibiotics and admission would only be warranted in cases of more significant infections or other severe complications, which are not indicated in this scenario with a small tear.