1. In swimmer’s ear, the tympanic membrane is often distorted. Occam’s razor will tell you that a child is unlikely to have both otitis externa and otitis media (OM) at the same time, and, because treating OM in older children is optional anyway,1 according to current guidelines, one can do just fine with only a topical preparation.
2. Missing an early ear infection is not that big a deal. Either it will go away on its own, or it will worsen and then the picture will be clearer. One does not need to treat dubious unilateral ear infections in the otherwise well infant aged older than 6 months.1
3. I have found that ear tugging in an infant, in the absence of supportive findings such as fever, pain, or having a cold, is not a sign of an ear infection, and I do not bring happy ear-tuggers into the office to be seen. I call this the “Carol Burnett sign” (Carol Burnett tugs her left ear after a performance to tell her grandmother she loves her).
4. If a child in the family has conjunctivitis requiring antibiotic drops, I tell the family it will be okay to treat other children who come down with it that week, without an office visit, provided they are otherwise well (eg, there is not a concern for an associated ear infection).