D: What brings you in?

P: Yeah, so uh I'm just bringing my son uh here to the clinic. He's been having um just I think he's been complaining of uh ear ache in his uh I think it's mainly in his left ear for the last, I'd say at least a week. Um he's been kind of just having discomfort um and over the last few days uh he also started crying because of how much pain he is having, and then um we also noticed that he had like was just feeling warm, so we took his temperature and he actually had a fever just yesterday of like 39 degrees Celsius.

D: OK, uhm, alright. So let's back up just a little bit. The ear pain, when did that start? You said a couple of days ago, so was that two, three, four days? 

P: Uh I think the discomfort like uh, we saw him scratching his ear for the whole last week, but uh the crying actually started just I would say four days ago, um. 

D: OK.

P: So I think the last few days have been really tough for him.

D: Yeah, so three, four days. OK, have you taken a look into his ear? Like does does it seem red? Is there discharge?

P: Uh I think we did see some uh, just like it wasn't red or anything, but I think we did uh see some um just kind of clear to almost uh clear to yellowish fluid from his affected ear.

D: OK, clear to, you said white-ish? 

P: Uh like it was a bit of a yellow tinge to to it as well.

D: Yellow, OK, OK. And which ear was it, sorry, the right or left?

P: Left ear. 

D: Left ear, OK. And the right ear looks normal?

P: Yeah, right ear, he hasn't been complaining uh at all. I haven't even looked at the right ear yet.

D: OK, is he itching his ears at all?

P: Uh he was he was itching like pretty much this whole week, but I think right now he's hesitant to even touch his ears.

D: OK, and does it look like it's angry on the outside or on the inside of his ears?

P: I can't really see anything on the outside.

D: OK, OK, and have you noticed that his hearing has changed at all?

P: Um he still like answers to us and like I don't think his ear, hearing is affected.

D: OK. Has he had any past issues with his ears, like ear infections or like hearing issues in the past?

P: Uh no hearing issues, but he did have uh like he used to, probably when he was uh like 2 years old, he did have a couple ear infections.

D: OK, OK. Were they were they treated with antibiotics?

P: Uh I think one time they were, but I I'm pretty sure that was on, in his right ear.

D: OK, OK. He's never had to get like tubes inserted or anything like that?

P: No, no, nothing like that.

D: No, OK. Um, alright. Um has he had a stuffy nose or runny nose?

P: Uh not this week, but he he was a bit like stuffy like last week I would say.

D: OK, he was a bit stuffy, you said?

P: Yeah, maybe even, maybe two weeks ago.

D: OK. And that stopped. Did he have anything else along with his stuffy nose at that point?

P: No, nothing else.

D: Um right now, have you noticed any changes in his vision, in his smell or taste?

P: Uh mo, not that I know of.

D: OK, how about weight loss?

P: No, he's been um growing pretty well.

D: OK, and you said um you had taken his temperature. When did you take his temperature?

P: I just took it yesterday but uh he was feeling a bit warm yesterday so we just took it and it was like um 39 degrees Celsius.

D: OK, OK sweet. Um so 39 degrees, so he does have a fever uh for sure. We'll take his temperature again today just to make sure. Have you been giving him anything for his high temperature, like Tylenol?

P: No, we haven't given him anything.

D: OK. Have you noticed any rashes on him?

P: No.

D: No, um how about coughing?

P: Uh no, he hasn't been really coughing.

D: No coughing, how about wheezing or shortness of breath? 

P: No.

D: Like anything that would indicate he has chest pain or palpitations of his heart?

P: No, I don't think so.

D: No, OK. Any dizziness or fainting spells?

P: No.

D: Confusion?

P: No, I don't think so.

D: Headaches?

P: Uh not that I know of.

D: OK, and how how have his bowel movements been?

P: His bowel movements have been pretty much the same, um he's uh, yeah, there's been no real changes.

D: No, OK. Um alright, and how about uh nausea or vomiting?

P: Uh no, no, no nausea or vomiting.

D: Any appetite change?

P: Uh no, uh, maybe a little bit more fussy just, but I don't know if that's probably due to the pain. 

D: OK. Um and how about his urine?

P: Uh his urine has been the same, like no changes.

D: No changes, OK good. Is he an otherwise healthy kid or does he have any longstanding conditions?

P: Yeah, he's pretty healthy. There have been no concerns at all that we've had for the doctor. Uh he's been growing well, um meeting all of his milestones. Um yeah, no, nothing that's concerning.

D: OK, um do you know if his mother's pregnancy with him was normal? Did she have any complications?

P: Um she didn't have any like complications during the pregnancy. Uh they did have to, um I forgot what it's called, but uh he was like a difficult baby coming out. Um and he was at term though, he wasn't premature, but they had to use just um some tools to get him out.

D: OK, OK. Um so it was a vaginal delivery, but they used some tools like forceps maybe or vacuum?

P: Yeah, yeah it was forceps, yeah.

D: OK, OK. Um and he's, you mentioned he was full term?

P: Yeah, he was born at uh 40 weeks.

D: OK, perfect. Did he need to be hospitalized for any reason after that?

P: No, he wasn't hospitalized. Uh we stayed there maybe one day extra just because um there was some just kind of misshaping of his head.

D: OK.

P: That kind of went away. 

D: OK, OK, good. And is he on any medications? 

P: Uh no, no medications.

D: No medications, up to date with his immunizations?

P: Yeah, he's all up to date.

D: OK, any allergies?

P: Um not that we know of.

D: OK, how about family history of lung conditions, heart conditions?

P: Um no, we've been pretty healthy as parents. Um and I think my my father has like high blood pressure, diabetes, and all those types of things.

D: OK, OK, any um ear issues like congenital ear, sorry um, genetic hearing issues or ear issues? 

P: No, nothing like that.

D: OK, um does anyone at home smoke?

P: No, no one smokes.

D: OK. Um and who does he live with?

P: So he lives with um me, his father, and his mother as well. 

D: OK. Uhm, any siblings?

P: No siblings, he's an only child.

D: OK, and how are things at home, um is like, are things financially stable? Any relationship issues?

P: No, we've been pretty uh fortunate like it it's, no financial issues uh and we have a lot of support from our parents as well. Uh the relationship is great, so no, no issues.

D: OK, good good. Um has he had any sick contacts recently?

P: Um I don't think so. He's, we've been at home so I don't know. We we did have like, with our with my brother's uh kids like uh they came to see us once um but that was like, that was, I think at like three weeks ago.

D: OK, OK, three weeks ago. Alright, um travel to anywhere recently?

P: No.

D: No, OK. Alright, those were all the questions I had for you today. Do you have any questions that you wanted to ask me today before we end the interview?

P: Uh no, not really. Just wanted to know if, like I remember he did need antibiotics before so I was just wondering if he needs them now.

D: Yeah, um so, well first, because some of his symptoms overlap with Covid, like the fever especially, we'll do a swab on him anyways um and you should hear those results in about 24 to 48 hours. Um and then it, this picture sounds like acute otitis media, so like an ear infection. And um it's especially likely because he's had them in the past, so I'm gonna have to take a look into his ears first before like um coming up with a management plan. But I'll kind of walk you through what we look at. So if I take a look and I see like a perforated tympanic membrane with like pus, we'd prescribe like 10 days of um antibiotics. If he has some like middle ear effusion, so like some fluids with like a bulging tympanic membrane and he appears to be really ill, uh which from the sounds of it, he sounds ill, he's had this fever for more than two days, we'll also prescribe antibiotics for 10 days. And then, if it's just some middle ear effusion, so just that clear fluid um or just the bulging tympanic membrane, we can just um reassess him in 24 to 48 hours to see how he's doing. And if he's worse, again, we'll prescribing prescribe him some antibiotics. Um the antibiotics that we usually prescribe are amoxicillin, and because he doesn't have a penicillin allergy, that should work.

P: OK.

D: Yeah, how does that sound?

P: That sounds good. Thank you so much.

D: OK, great, thank you.