Explaining glue ear and the watchful-waiting plan — OSCE

Candidate instructions (8-minute station)

You are the paediatric registrar in the general practice clinic. A 2-year-old boy is brought in two weeks after a cold because he has been turning the television up loud. He is well and afebrile. Otoscopy shows a dull, retracted right tympanic membrane with a faint fluid level; the left ear is normal. The parent is anxious and wants to know whether the ear is infected, whether he needs antibiotics, and whether he will need an operation. ^[2]

Your tasks are: ^[3]

1. Explain the diagnosis of glue ear (otitis media with effusion) in plain language and reassure the parent that this is not an acute ear infection. ^[2]
2. Explain why no antibiotics or surgery are needed right now, and outline the watchful-waiting plan with the three-month reassessment. ^[7]
3. Give clear, specific advice on supporting his hearing and speech at home during the waiting period. ^[3]
4. Give a clear safety-net for the features that would mean an earlier return, including the signs of an acute ear infection. ^[3]

You are not expected to arrange grommets or imaging for this child today, because the effusion has been present for only two weeks and does not meet the three-month threshold. ^[3]