ABSTRACT
This chapter presents a case study of a 4-year-old child who is admitted to emergency department with right-sided otalgia. Right-sided otoscopic examination demonstrates a normal external auditory canal with a bulging, red, intact tympanic membrane. The pinna is pushed outwards due to a tender, warm, fluctuant retroauricular swelling. The left ear examination is unremarkable. Examination of the nose and throat demonstrates rhinitis and mild tonsil swelling consistent with an upper respiratory tract infection. This patient has acute otitis media (AOM), which is complicated by mastoiditis. This is a paediatric ENT emergency, which can have immediate and long-term complications. These include extracranial complications such as hearing loss, facial nerve palsy and a Bezold (sternocleidomastoid) or Citelli (posterior belly of digastric muscle) abscess. Intracranial complications are also possible, including meningitis or intracranial abscesses. Following a comprehensive history and examination, appropriate investigations include an ear swab for submission to microbiology, especially if there is ear discharge.
