2/1/25, 1:34 PM Rubric Assessment - FNP593 Sect2 Primary Health Of Acute Clients/Families Across The Lifespan - United States University USU NUR Research Paper Rubric Course: FNP593 Sect2 Primary Health Of Acute Clients/Families Across The Lifespan Criteria Introduction/O bjective Superior Above Average Competent Below Standard Far Below Standard Criterion Score 5 points 4 points 3 points 2 points 1 point /5 Objective is precise, knowledgeable, significant, and distinguished from alternate or opposing options. Objective is precise and knowledgeable. Objective is acceptable. Objective may be unclear or irrelevant. Objective is missing. https://classroom.usuniversity.edu/d2l/lms/competencies/rubric/rubrics_assessment_results.d2l?ou=103905&evalObjectId=811456&evalObjectType=1&userId=51974&viewTypeId=3&rubricId=813456&groupId=0&d2l_b… 1/5 2/1/25, 1:34 PM Criteria Scope/Evidenc e Rubric Assessment - FNP593 Sect2 Primary Health Of Acute Clients/Families Across The Lifespan - United States University Superior Above Average Competent Below Standard Far Below Standard Criterion Score 5 points 4 points 3 points 2 points 1 point /5 Skillfully arranges evidence to setup premise of the issue. Clearly sets up premise of the issue. Sets up premise of issue. Poorly sets up the premise of the issue No premise set up. Persuasively builds the case with supportive evidence. Persuasively builds the case. Sufficiently persuasive to the case. Covers key points Adequate of the issue. development of key issues. Elaborates on all key points of the issue. Analysis Minimally persuasive to the case. Not persuasive to the case. Absence of key issues. Poor development of key issues. 5 points 4 points 3 points 2 points 1 point Skillful recommendation s and/or specific action. Suggested action is reasonable. Clear recommendation s and/or specific action. Suggested action is reasonable Sufficient recommendation s and/or specific action. Suggested action is reasonable. Vague about specific action. Absence of specific action. Action minimally reasonable. Action completely unreasonable. /5 https://classroom.usuniversity.edu/d2l/lms/competencies/rubric/rubrics_assessment_results.d2l?ou=103905&evalObjectId=811456&evalObjectType=1&userId=51974&viewTypeId=3&rubricId=813456&groupId=0&d2l_b… 2/5 2/1/25, 1:34 PM Criteria Conclusion Rubric Assessment - FNP593 Sect2 Primary Health Of Acute Clients/Families Across The Lifespan - United States University Superior Above Average Competent Below Standard Far Below Standard Criterion Score 5 points 4 points 3 points 2 points 1 point /5 Conclusion is precise, knowledgeable, significant, and distinguished from alternate or opposing options. Skillfully implicates impact on nursing practice, patient safety and healthcare quality. Conclusion is precise knowledgeable and significant. Conclusion is appropriate. Conclusion may be unclear or irrelevant. Conclusion and/or Clearly states impact on nursing practice, patient safety and healthcare quality. Provides a basic explanation of the impact on nursing practice, patient safety and healthcare quality. impact is missing. Vague references regarding impact. https://classroom.usuniversity.edu/d2l/lms/competencies/rubric/rubrics_assessment_results.d2l?ou=103905&evalObjectId=811456&evalObjectType=1&userId=51974&viewTypeId=3&rubricId=813456&groupId=0&d2l_b… 3/5 2/1/25, 1:34 PM Criteria Integration of Knowledge Writing Style, Formatting and Conventions Rubric Assessment - FNP593 Sect2 Primary Health Of Acute Clients/Families Across The Lifespan - United States University Superior Above Average Competent Below Standard Far Below Standard Criterion Score 5 points 4 points 3 points 2 points 1 point /5 Demonstrates understanding and applies concepts learned in the course at a superior level. Concepts are integrated into insights. Provides concluding remarks that show analysis and synthesis of ideas. Demonstrates understanding and applies concepts learned in the course. Conclusions are supported in reflection. Demonstrates, for the most part, understanding and applies concepts learned in the course. Some of the conclusions, however, are not supported. Demonstrates, to a certain extent, understanding and applies some concepts learned in the course. Does not demonstrates full understanding of concepts learned in the course. 5 points 4 points 3 points 2 points 1 point Appropriate references that Appropriate references that Appropriate references that Minimal references and Opinions and recommendation support opinions and recommendation s. Exceptional writing with no grammar, APA or spelling errors support opinions and recommendation s. Excellent writing with minimal grammar, APA or spelling errors support opinions and recommendation s. Sufficient writing with minor, APA or spelling errors support for opinion on policy and recommendation s for changes. Many APA/Grammar and/or spelling errors. s not well supported, Poor APA/Grammar and /or spelling /5 https://classroom.usuniversity.edu/d2l/lms/competencies/rubric/rubrics_assessment_results.d2l?ou=103905&evalObjectId=811456&evalObjectType=1&userId=51974&viewTypeId=3&rubricId=813456&groupId=0&d2l_b… 4/5 2/1/25, 1:34 PM Rubric Assessment - FNP593 Sect2 Primary Health Of Acute Clients/Families Across The Lifespan - United States University Total / 30 Overall Score Level 5 Level 4 Level 3 Level 2 Level 1 24 points minimum 19 points minimum 14 points minimum 9 points minimum 0 points minimum https://classroom.usuniversity.edu/d2l/lms/competencies/rubric/rubrics_assessment_results.d2l?ou=103905&evalObjectId=811456&evalObjectType=1&userId=51974&viewTypeId=3&rubricId=813456&groupId=0&d2l_b… 5/5 1 Title of paper United States University Course Name Date 2 Title of paper Type your introduction paragraph here. Discuss what this paper will be about and the various topics that will be covered. Don’t forget to cite your sources throughout your paper. Avoid long quotes, if a long quote is absolutely necessary; be sure it is properly formatted per APA 7th edition guidelines. Review of topic and rationale for selection of topic Discuss why you chose this topic/patient experience for your paper. Why is it an important health care issue? Be sure to reference your appendices as needed by typing (See Appendix A). See the APA manual if you are unsure how to use Appendices. Evaluation of key concepts related to the topic Discuss the key concepts related to this topic/disease process/situation. Description of multiple viewpoints Is there more than one guideline for this condition? How are they different? Is there any conflicting data, beliefs, or controversy surrounding this condition or treatment? Assessment of the merit of evidence found on this topic (soundness of research) Discuss the quality of the research/studies that you reviewed. Evaluation of current EBM guidelines If guidelines exist for this condition, explain and discuss them. If there are no guidelines, recommend what these guidelines should be based on available research Diversity, cultural, spiritual, and socioeconomic considerations Discuss these special considerations regarding this illness/treatment. Discussion regarding the Standardized Procedure for this diagnosis 3 If you were asked to develop a standardized procedure for this condition, what would you include? Discussion on how the evidence did impact/would impact practice This is a reflection portion. What would you have done differently based on what you learned while conducting your research about the topic? Conclusion Type your conclusion paragraph here. References 4 Appendix A 5 Copy and paste comprehensive SOAP note here Appendix B 6 Copy and paste focused/follow up visit SOAP note here Week 7 Signature Assignment Instructions FNP 593 SYLVIA HAGBERG-FITCH, MSN, FNP-BC, ACACNP-BC The basic requirements for the Week 7 Signature Assignment paper  Paper should be no longer than 10 pages, excluding references and appendices. • Review topic and explain rationale for topic selection in the context of client care. • Evaluates key concepts related to the topic. • Describes multiple viewpoints if this is a controversial issue or one for which there are no clear guidelines. • Assess the merit of evidence found on this topic i.e. soundness of research • Evaluates current guidelines for patient diagnosis, if available you should use the actual guideline, not a secondary source. If there is no guideline, you should recommend what these guidelines should be based on available research. • Discuss the Standardized Procedure for this diagnosis. The AANP website has a nice outline what the standardized procedure should include, see link: https://www.aanp.org/advocacy/advocacy-resource/positionstatements/standards-of-practice-for-nurse-practitioners • Discuss how the evidence did impact/would impact practice. What should have been done differently based on the knowledge gained? • Consider cultural, spiritual, and socioeconomic issues as applicable.  Important essentials for this assignment.      Select a client from your past or current FNP clinical rotations with an acute health problem or complaint which required at least two visits. Conduct a literature search for two research articles based on this client’s condition, the research articles must be original research contributions such as a randomized control trial, a new (novel) treatment or diagnostic modality for your main diagnosis. No review articles or meta-analysis articles, just original research, for these 2 research studies. The articles must have been published within the last five years. Incorporate the research findings into the decision-making for this client’s treatment. Assess the merit of evidence in the 2 original research articles you found on this topic and evaluate the soundness of research The discussion on relating research to practice should be approximately 3-4 pages of your paper. Evaluating the original research studies for soundness  The soundness of research refers to the overall quality, reliability, and validity of a study, ensuring that it is wellfounded, methodologically rigorous, and capable of producing credible results. It is typically evaluated based on the following criteria: • Validity – The degree to which the study accurately measures what it aims to assess. This includes: • • Internal validity: Ensuring the study design, methods, and controls effectively minimize bias and confounding variables. • External validity: Determining whether the findings can be generalized to other populations or settings. Reliability – The consistency and reproducibility of the results. A study is considered reliable if it yields the same or highly similar outcomes when repeated under comparable conditions. SOAP Note and Follow up note attachments  Attach the initial visit/comprehensive SOAP note and follow-up visit /focused SOAP note as appendices.  You may include SOAP notes that have already been submitted in your clinical courses.  If you are at a clinical site that does not see followups (Urgent Care, ER, minute-clinic, etc) then you may create a fictitious follow-up SOAP note addressing the issue with attention to items you would need to assess in the history and physical during the visit. Picking the patient/condition for the signature assignment and any questions you may have  Please reach out if you have any questions whether the patient and condition would be a good choice for the assignment  If you feel stuck with the assignment, and need suggestions please reach out to me!  Basically, reach out if you need any help or if there is something in the assignment that is not clear!  Look at the instructions in this presentation, look at the instructions in D2L and the rubric for the assignment, it is not a small assignment so the sooner you start the better and please ask for help as early as possible. ​ 1 Pediatric HEENT Soap Note United States University FNP 594: Primary Health for Acute Clients/Families Across the Lifespan Clinical Practicum March 12, 2025 ​ 2 Week 2 Health History Worksheet Subjective Data: ID: Initials: F.D. Age: 12 years old. DOB: June 12, 2012. Race: Caucasian. Sex: Male. Accompanied by (if applicable): The patient came to the clinic accompanied by his mother. Reliability as a historian: The patient is a reliable historian, accurately describing his current symptoms. However, his mother provided additional details regarding his medical history, as the patient is unable to recall certain aspects. Chief Complaint (CC): The patient’s CC: “My ear hurts, and I can’t hear well on one side.” The mother’s CC for the patient: “He’s been complaining of ear pain and seems to have trouble hearing.” History of Present Illness (HPI): F.D. is a 12-year-old male presenting with right ear pain for the past three days, which has worsened over the past 24 hours. The pain was initially sharp and intermittent but has become more constant, with a severity of 6/10. He describes a feeling of fullness and muffled hearing in the affected ear. His mother reports a low-grade fever (100.2°F) last night and has noticed him frequently tugging at his ear. The pain worsens with chewing, lying down on the affected side, or when the ear is touched, while Ibuprofen provided temporary relief. He denies ear drainage, dizziness, nausea, vomiting, or headache. His symptoms began following a week of nasal congestion and a mild cough. There is no history of foreign body insertion or ear trauma. Past Medical & Psychiatric History: No past medical or psychiatric history. ​ 3 Surgeries: The patient’s mother reports no previous surgeries. Hospitalizations: The patient’s mother reports no history of hospitalizations. OB/GYN History: N/A. Preventative Care/Immunization: The patient’s mother reports her child being up-to-date on all vaccinations. Last physical in July of 2024 (vision check, dental visit). Medications: The patient’s mother reports no medications. Allergies: The patient’s mother reports no allergies. The patient’s mother denies any allergies to medication. The patient’s mother denies seasonal allergies. Chemical History: Tobacco Use/Vaping: Question omitted. Alcohol Use: Question omitted. Caffeine Intake: Question omitted. Illicit or Recreational Drug Use: Question omitted. Social History: Marital/Support Status: F.D. lives with both parents in a stable and supportive home environment. He shares a strong relationship with his mother and father, who are actively involved in his care. He attends middle school, where he benefits from a supportive network of teachers and school staff. F.D. participates in sports, primarily tennis with occasional basketball, which provides opportunities for peer interaction and social engagement. He has a good group of friends at school and takes part in various social activities. There are no reported concerns regarding bullying, social isolation, or behavioral issues. Sexual History: Question omitted. Exercise/Diet: F.D. stays active by playing tennis regularly and occasionally basketball. He enjoys outdoor activities and participates in school recess but does not follow a structured exercise routine. Screen time does not interfere with his activity levels. He eats three meals daily ​ 4 with occasional snacks, mainly consuming carbohydrate-rich foods like pasta, rice, and bread. Though he eats fruits and vegetables, his intake could improve. He primarily drinks water and juice, rarely consuming soda. His family provides home-cooked meals, with occasional processed or fast food. Occupation: F.D.’s mother works as an administrator at his school, enabling her to stay actively engaged in his education and daily activities. His father, a software engineer, ensures financial stability for the family. Education: F.D. is currently in 6th grade at his local middle school, where he performs well academically and enjoys learning. There are no concerns regarding his cognitive development or school performance. He interacts well with teachers and peers and actively participates in school activities. His parents are involved in his education, ensuring he completes assignments and has access to necessary resources. No learning disabilities, behavioral issues, or concentration difficulties have been reported. Housing Situation: F.D. lives with both parents in a stable and supportive home environment. As an only child, he has a strong support system within his immediate family. His parents are actively involved in his upbringing, ensuring his medical and emotional needs are met. Sleep/Stress Levels: The patient’s mother reports her son gets adequate sleep of 8-9 hours. Spiritual/Religious Affiliation: Christian. Safety Concerns: F.D.’s mother reports no safety concerns within the home. The household does not contain firearms, and all potentially hazardous items, including cleaning products, medications, and alcohol, are securely stored out of reach. He is always supervised during outdoor activities, and his parents ensure he follows safety guidelines, such as wearing a seatbelt in the car and a helmet when biking. They confirm no exposure to secondhand smoke, allergens, or harmful chemicals. The local air quality is rated B/C, with no significant impact on his health. There are no concerns regarding bullying, neighborhood safety, or other environmental risks. Activities of Daily Living (ADLs): F.D. is largely independent in his activities of daily living but still benefits from occasional parental guidance. He manages his own hygiene routine, though his mother provides reminders as needed. He independently chooses his clothing but may receive input to ensure it is weather-appropriate. He eats on his own, with meals prepared by his mother. He completes homework and school assignments without assistance but checks in with his parents for support when necessary. He contributes to household tasks, such as keeping his room tidy and setting the table. His mother has no concerns about his ability to manage daily tasks, and there are no mobility, coordination, or fine motor skill issues affecting his independence. ​ 5 Family History: Mother: Alive, 34 years old, with a history of gestational diabetes. Father: Alive, 36 years old, with no known medical conditions. Siblings: No siblings. Maternal/Paternal Grandparents: His maternal grandparents are alive, with his grandmother being 59 years old and his grandfather 62 years old, both having a history of HTN, DM, and high cholesterol. His paternal grandparents are also alive, with his grandmother being 65 years old and his grandfather 68 years old. Both paternal grandparents have HTN, and his paternal grandfather also has a history of MI, HL, and DM. Review of Systems (ROS): The ROS was conducted with the mother’s aid. Constitutional: The patient denies recent weight loss or gain and reports no fatigue, chills, or night sweats. Fever last night of 100.2°F. Eyes: Denies blurred vision, double vision, eye pain, redness, tearing, discharge, photophobia, or recent changes in vision. Ears: Reports right ear pain, muffled hearing, and a sensation of fullness. Denies left ear pain, ear drainage, tinnitus, vertigo, or previous ear infections. Nose: Reports nasal congestion and clear rhinorrhea but denies facial pain, sinus pressure, epistaxis, or recent exposure to allergens. Throat/Mouth: Denies sore throat, difficulty swallowing, odynophagia, hoarseness, or recent dental pain. Cardiovascular: Denies chest pain, palpitations, syncope, dizziness, or exercise intolerance. No history of murmurs or known cardiac conditions. Respiratory: Reports mild cough over the past week but denies shortness of breath, wheezing, hemoptysis, or recent respiratory infections beyond mild cold symptoms. Gastrointestinal: The patient denies nausea, vomiting, abdominal pain, constipation, diarrhea, or heartburn. Genitourinary: Denies dysuria, frequency, urgency, hematuria, incontinence, or recent urinary tract infections. ​ 6 Musculoskeletal: The patient denies joint pain, stiffness, or swelling, as well as muscle weakness, aches, or movement difficulties. Integumentary/Breast: The patient denies any skin changes, moles, rashes, or discoloration. Neurological: Patient denies dizziness and syncope. Psychiatric: The patient denies depression, anxiety, or sleep disturbances. Endocrine: The patient denies mood changes and sleep disturbances. Hematologic/Lymphatic: The patient denies bruising, unusual bleeding, or swollen lymph nodes in the neck, underarms, or groin. Allergic/Immunologic: The patient reports no seasonal allergies or increased sensitivity to dust or pollen. Objective Data Vital Signs: HR: 83 bpm BP: 110/72 mmHg Temp: 99.2°F RR: 18/min SpO2: 100% on room air Pain: 6/10 right ear pain. Weight: 94lbs Height: 4'10” BMI: 19.64 kg/m^2 Labs: No lab tests were ordered during this visit. Physical Exam: ​ 7 General Survey: The patient is comfortable, alert, and oriented. Well-nourished, well-developed 12-year-old male in no acute distress. HEENT: Head: Normal shape, no tenderness. Eyes: PERRLA (pupils equal, round, reactive to light and accommodation). No redness, tearing, or discharge noted. Extraocular movements are intact. No visual field deficits were detected during confrontation testing. A fundoscopic exam reveals no papilledema or abnormalities in the optic disc. Ears: Right tympanic membrane is erythematous, bulging, and has a loss of the light reflex. Decreased mobility noted on pneumatic otoscopy. Left tympanic membrane is intact, pearly gray, with a visible cone of light. No perforation or drainage noted. Nose: Mild nasal congestion with clear rhinorrhea. Nasal passages are patent bilaterally, with pink mucosa and mild edema. No purulent discharge, septal deviation, or lesions noted. Throat/Mouth: Throat: Mucosa is pink and moist. Tonsils are present without erythema, lesions, or exudates. No oropharyngeal swelling or ulcerations noted. Cardiovascular: Regular rate and rhythm, no murmurs, rubs, or gallops. Pulses 2+ and symmetric bilaterally. Capillary refill less than 3 seconds. Respiratory: Chest wall symmetric with normal respiratory effort and no use of accessory muscles. Percussion is resonant throughout, with no tenderness noted to palpation. Mild, non-productive cough noted during the exam. Clear to auscultation bilaterally. No wheezing, crackles, or rhonchi. Neurological:The patient is alert and oriented to person, place, time, and situation. Speech is fluent and clear. Cranial nerves II–XII are intact: visual acuity is grossly intact bilaterally, peripheral vision is intact to confrontation, and extraocular movements are full without nystagmus. Skin: Warm, dry, no rashes, lesions, or abnormal pigmentation. No signs of erythema or swelling around the affected ear. Assessment: Primary Diagnosis: ​ 8 Otitis Media, Unspecified, Right Ear (ICD-10: H66.91): This diagnosis is well supported by both subjective and objective findings. The patient's right ear pain, muffled hearing, sensation of fullness, and mild fever are hallmark symptoms of otitis media, indicating middle ear inflammation and fluid accumulation (Jamal et al., 2022). On examination, the erythematous and bulging tympanic membrane, loss of the light reflex, and decreased mobility on pneumatic otoscopy confirm middle ear infection and pressure buildup (Mankowski & Raggio, 2023). Differential Diagnoses: Unspecified Eustachian Tube Disorder, Right Ear (ICD-10: H69.91: This diagnosis is considered due to the patient's nasal congestion and complaints of ear fullness, which are commonly associated with Eustachian tube dysfunction (ETD) (Bal & Deshmukh, 2022). However, ETD alone does not typically cause acute ear pain or fever, which are present in this case (Alshehri & Musleh, 2025). Additionally, pneumatic otoscopy in ETD usually reveals a retracted tympanic membrane with normal or slightly reduced mobility (Bayoumy et al., 2022). This patient’s tympanic membrane is bulging, erythematous, and exhibits decreased mobility, confirming an infectious process rather than isolated ETD (Jamal et al., 2022). Acute Serous Otitis Media, Right Ear (ICD-10: H65.01): This diagnosis was also considered. Serous otitis media occurs when fluid accumulates in the middle ear without an active bacterial infection and is often followed by URIs or allergies (Mârțu et al., 2022). Patients with serous otitis media typically present with hearing loss, ear fullness, and mild discomfort rather than acute ear pain and fever (Mârțu et al., 2022). On otoscopic examination, serous otitis media is characterized by a clear or amber-colored effusion, a normal or slightly retracted tympanic membrane, and an absence of significant erythema or bulging (Danishyar & Ashurst, 2023). In contrast, this patient has a bulging, red tympanic membrane, fever, and significant pain, making acute otitis media the more likely diagnosis. Diffuse Otitis Externa, Right Ear (ICD-10: H60.311): This diagnosis was ruled out because while it can cause ear pain, it usually presents with external ear tenderness, swelling, and pruritus, which this patient lacks (Smith et al., 2021). Otitis externa is often linked to recent swimming, water exposure, or ear canal trauma, none of which were reported (Smith et al., 2021). The pain in otitis externa worsens with auricle or tragus manipulation, but this patient’s pain is localized deeper in the ear and remains unchanged with external touch. The absence of ear discharge and a normal external auditory canal further support acute otitis media over otitis externa (Smith et al., 2021). Plan ​ 9 Diagnostics: No laboratory tests or imaging are needed. Otitis media is a clinical diagnosis based on history and otoscopic findings. If symptoms persist beyond 48-72 hours despite treatment, further evaluation may be required. Worsening symptoms, recurrent infections, or complications such as mastoiditis, hearing loss, or persistent effusion would warrant additional testing. Possible evaluations include tympanometry, audiology testing, or imaging (Danishyar & Ashurst, 2023). Referral to EENT will be considered if needed. Treatments: Pharmacological: ●​ Amoxicillin 80-90 mg/kg/day divided BID for 10 days (Katz et al., 2024). ●​ If allergic to penicillin: Cefdinir 14 mg/kg/day OR Azithromycin 10 mg/kg on Day 1, followed by 5 mg/kg/day for 4 days (Katz et al., 2024). ●​ Ibuprofen (Children’s Motrin): 10 mg/kg every 6-8 hours PRN for pain/fever. Parents were advised to administer it with food to reduce gastrointestinal discomfort. Do not exceed 40 mg/kg/day (Jin et al., 2021). ●​ Acetaminophen (Children’s Tylenol): 10-15 mg/kg every 4-6 hours PRN if NSAIDs are contraindicated. Parents were reminded not to exceed 75 mg/kg/day (Jin et al., 2021). Non Pharmacological: ●​ Hydration & Humidification: Encourage adequate fluid intake and use of a cool mist humidifier to thin mucus and improve Eustachian tube drainage (Byber et al., 2021). ●​ Nasal Saline Spray & Suctioning: Use of saline nasal spray or gentle suctioning to reduce nasal congestion, which may help relieve Eustachian tube dysfunction contributing to middle ear pressure (Ahmed & Eldeeb, 2022). ●​ Rest & Symptom Monitoring: Ensure adequate rest and monitor for worsening symptoms, such as severe pain, drainage, or high fever (>102°F), which may indicate treatment failure. Education: The mother was educated on the etiology of otitis media, emphasizing that it is often secondary to upper respiratory infections due to Eustachian tube dysfunction, which allows fluid accumulation and bacterial overgrowth (Jamal et al., 2022). The importance of completing the full 10-day antibiotic course, even if symptoms improve, was stressed to prevent resistance and recurrent infections. The mother was reminded to administer medications as prescribed and to ​ 10 avoid exceeding the maximum daily doses of ibuprofen and acetaminophen. She was also cautioned against using multiple acetaminophen-containing products simultaneously to avoid overdose. The child was involved in the education process using age-appropriate language and was reassured that ear pain and fullness would improve with treatment. He was reminded to notify an adult if his pain worsens, if he experiences dizziness, or if he has trouble hearing. Follow-Up: The patient will have a routine follow-up in 10-14 days to assess symptom resolution and tympanic membrane status (Jamal et al., 2022). Parents were instructed to return sooner if the child experiences worsening pain, persistent fever above 102°F, new ear drainage, significant hearing loss, or swelling, redness, or tenderness behind the ear, which could indicate mastoiditis (Cassano et al., 2020). If symptoms persist beyond three months, an EENT referral will be done. ​ 11 References Ahmed, M. R., & Eldeeb, W. E. (2022). Effectiveness of mometasone furoate nasal spray on tympanometric results and hearing loss in children with otitis media with effusion. Egyptian Journal of Otolaryngology, 38, 32. https://doi.org/10.1186/s43163-022-00225-x Alshehri, S., & Musleh, A. (2025). The role of Eustachian tube dysfunction in recurrent chronic otitis media: A cross-sectional study of anatomical and functional variations. Healthcare, 13(1), 77. https://doi.org/10.3390/healthcare13010077 Bal, R., & Deshmukh, P. (2022). Management of Eustachian tube dysfunction: A review. Cureus, 14(11), e31432. https://doi.org/10.7759/cureus.31432 Bayoumy, A. B., Veugen, C. C. A. F. M., van der Veen, E. L., Bok, J. M., de Ru, J. A., & Thomeer, H. G. X. M. (2022). Management of tympanic membrane retractions: A systematic review. European Archives of Oto-Rhino-Laryngology, 279(2), 723–737. https://doi.org/10.1007/s00405-021-06719-3 Byber, K., Radtke, T., Norbäck, D., Hitzke, C., Imo, D., Schwenkglenks, M., Puhan, M. A., Dressel, H., & Mutsch, M. (2021). Humidification of indoor air for preventing or reducing dryness symptoms or upper respiratory infections in educational settings and at the workplace. The Cochrane Database of Systematic Reviews, 12(12), CD012219. https://doi.org/10.1002/14651858.CD012219.pub2 Cassano, P., Ciprandi, G., & Passali, D. (2020). Acute mastoiditis in children. Acta Bio-Medica: Atenei Parmensis, 91(1-S), 54–59. https://doi.org/10.23750/abm.v91i1-S.9259 Danishyar, A., & Ashurst, J. V. (2023). Acute otitis media. In StatPearls. StatPearls Publishing. Retrieved from http://ncbi.nlm.nih.gov/books/NBK470332/ Jamal, A., Alsabea, A., Tarakmeh, M., & Safar, A. (2022). Etiology, diagnosis, complications, ​ 12 and management of acute otitis media in children. Cureus, 14(8), e28019. https://doi.org/10.7759/cureus.28019 Jin, J., Wang, X., Wang, J., & Wan, Z. (2021). Efficacy and safety of ibuprofen in children with musculoskeletal injuries: A systematic review and meta-analysis of randomized controlled trials. Medicine, 100(26), e26516. https://doi.org/10.1097/MD.0000000000026516 Katz, S. E., Jenkins, T. C., Stein, A. B., Thomas, G., Koenig, N., Starnes, G. L., Newland, J. G., Banerjee, R., & Frost, H. M. (2024). Durations of antibiotic treatment for acute otitis media and variability in prescribed durations across two large academic health systems. Journal of the Pediatric Infectious Diseases Society, 13(9), 455–465. https://doi.org/10.1093/jpids/piae073 Mankowski, N. L., & Raggio, B. S. (2023). Otoscope exam. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK553163/ Mârțu, C., Cozma, S., Cobzeanu, B., Vesa, D., Butnaru, C., Bularda, D., Cumpătă, A., & Rădulescu, L. (2022). Serous otitis media: Clinical and therapeutic considerations, including dexamethasone (C₂₂H₂₉FO₅) intratympanic injection. Experimental and Therapeutic Medicine, 23(2), 125. https://doi.org/10.3892/etm.2021.11048 Smith, M. E., Hardman, J. C., Mehta, N., Jones, G. H., Mandavia, R., Anderson, C., Khan, M., Abdelaziz, A., Al-Dulaimy, B., Amin, N., Anmolsingh, R., Anwar, B., Bance, M., & INTEGRATE (The UK ENT Trainee Research Network). (2021). Acute otitis externa: Consensus definition, diagnostic criteria, and core outcome set development. PLOS ONE, 16(5), e0251395. https://doi.org/10.1371/journal.pone.0251395 
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