A 5-year-old male is brought to the primary care clinic by his mother with a chief complaint of bilateral ear pain with acute onset that began yesterday. The mother states that the child has been crying frequently due to the pain. Ibuprofen has provided minimal relief. This morning, the child refused breakfast and appeared to be getting worse.
Vital signs at the clinic reveal HR 110 bpm, 28 respiratory rate, and tympanic temperature of 103.2 degrees F. Weight is 40.5 lbs. The mother reports no known allergies. The child has not been on antibiotics for the last year. The child does not have history of OM. The child is otherwise healthy without any other known health problems.
Physical examination reveals:  Vital signsl HR 110 bpm, 28 respiratory rate, and tympanic temperature of 103.2 degrees F. Weight is 40.5 lbs. Bilateral TMs are bulging with severe erythematous. Pneumatic otoscopy reveals absent mobility. Ear canals are nomal.
After your questioning and examination, you diagnose this child with bilateral Acute Otitis Media.