You are seeing a 4-year-old girl in the primary care clinic…
You are seeing a 4-year-old girl in the primary care clinic today. She has had a low grade fever of 100.5 for 3 days. She is complaining that her ears hurt with difficulty sleeping. She also has a non-productive cough that started yesterday. Examination of both ears reveals significant redness and fluid in both middle ears, immobility of the tympanic membranes, and loss of bony landmarks (see photo). Further examination of the patient’s breathing and other manifestations indicates an upper respiratory infection. The patient’s parents are chronic heavy smokers and the child is exposed to second hand smoke in the home environment. Which of the following is the most likely differential diagnosis?
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