What is the treatment for a 9-year-old patient with a cough, cold, and a clogged right ear?

Treatment for a 9-Year-Old with Cough, Cold, and Clogged Right Ear

For this 9-year-old with cough, cold, and a clogged right ear, provide symptomatic treatment only—no antibiotics, antihistamines, or decongestants are indicated unless bacterial infection is confirmed. 1, 2

Initial Assessment

The combination of cough, cold, and ear congestion strongly suggests a viral upper respiratory infection, not bacterial infection. 2 The clogged ear sensation is most likely otitis media with effusion (OME), which is fluid behind the eardrum without signs of acute infection. 1

Key Examination Points

• Examine the tympanic membrane to differentiate between OME (fluid without infection) and acute otitis media (AOM with infection). 1
• Look for signs requiring antibiotics: high fever, intense earache, bulging red tympanic membrane with loss of normal landmarks. 1
• Isolated redness of the tympanic membrane with normal landmarks is NOT an indication for antibiotics. 1
• Check for red flags: hemoptysis, severe systemic illness, respiratory distress, or foreign body aspiration history. 1

Recommended Treatment

Symptomatic Relief

Pain and fever management:

• Ibuprofen or acetaminophen for discomfort or fever control. 2
• Avoid aspirin due to Reye syndrome risk. 2

For the clogged ear (OME):

• No antibiotics, antihistamines, decongestants, or steroids are recommended for otitis media with effusion. 1
• The fluid typically resolves spontaneously within 3 months. 1
• Reassure the family that this is self-limited. 1

For cough:

• Do not use over-the-counter cough suppressants—they lack evidence of efficacy in children. 2
• Consider honey (if over 1 year old), adequate hydration, and humidified air for symptomatic relief. 2
• Cough from viral infections typically resolves within 2-4 weeks. 1

When Antibiotics ARE Indicated

Only prescribe antibiotics if:

• The child has acute otitis media (AOM) with bulging tympanic membrane, high fever, and intense earache. 1
• For children over 2 years with mild AOM symptoms, observation for 48-72 hours is reasonable before starting antibiotics. 1
• If antibiotics are needed: Amoxicillin 45 mg/kg/day divided every 12 hours (or 40 mg/kg/day divided every 8 hours) for 10 days. 3

What NOT to Do

Avoid these common pitfalls:

• Do not prescribe antibiotics for viral URI or OME—no benefit and increases resistance. 1, 2
• Do not use antihistamines or decongestants—ineffective and potentially harmful in children. 1
• Do not use intranasal or systemic steroids for OME. 1
• Do not assume the cough is asthma without specific indicators (wheeze, nocturnal symptoms, response to bronchodilators). 1, 4

Follow-Up Plan

Re-evaluate if:

• Symptoms worsen or fail to improve after 48-72 hours. 2
• Fever persists beyond 3-5 days. 2
• Ear pain becomes severe or new symptoms develop. 2
• Cough persists beyond 4 weeks—this becomes chronic cough requiring systematic evaluation with chest X-ray and specific algorithms. 1, 5
• OME persists beyond 3 months—refer to ENT specialist for possible tympanostomy tubes if associated with hearing loss. 1

Special Considerations

Arnold's ear-cough reflex:

• In rare cases (2.3-4.2% of children), stimulation of the ear canal can trigger cough. 1
• Remove any foreign material or hair touching the eardrum if present. 1
• However, this is an uncommon cause of chronic cough in children. 1

Environmental factors:

• Keep child away from secondhand smoke, which worsens respiratory symptoms and delays OME resolution. 1
• If child uses a pacifier and is over 12 months, stopping daytime pacifier use may help fluid resolve. 1