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You are seeing a 3 year old boy with unresolving right-sided ear infection. He was first seen 1 month ago and diagnosed with right AOM and prescribed 10 days of amoxicillin. He returned after completing that course with ongoing pain, was diagnosed with persistent right AOM, and prescribed 10 days of augmentin. He has completed the augmentin and was feeling a little bit better for a few days before his symptoms returned and then became worse. He now also has a fever to 101. During the few days he felt better, he did go to a waterpark. On exam, his external auditory canal is swollen and red. Partial view of his tympanic membrane reveals it to be bright red and bulging. He indicates his entire ear when asked where it hurts, and he has swelling and redness and tenderness to palpation behind his ear as well.
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August 23, 2023 at 6:09 pm
D) Obtain a CT scan
The boy is showing features of mastoiditis, particularly with postauricular redness, swelling, and tenderness. The affected ear may protrude when compared to the unaffected ear. Mastoiditis often follows acute otitis media and may show external auditory canal swelling. Other symptoms include ear pain, fever, and sometimes otorrhea. Up to 80% have AOM at presentation with mastoiditis. CT scan with contrast of the temporal bone is diagnostic. Disposition for mastoiditis is admission for IV antibiotics and ENT consultation.