A Boy With Sudden-Onset Left Otalgia and Otorrhea

Author:
Raul G. Lopez Valle, MD, MPH
Granberry Medical Care PLLC, Humble, Texas

Citation:
Lopez Valle RG. A boy with sudden-onset left otalgia and otorrhea. Consultant. 2019;59(8):237-238, 256.

A 9-year-old boy was brought to a primary care office by his mother. The patient had complained of self-limited sudden left otalgia the day before his visit. The mother was unsure whether the patient had had fever or not. However, she noticed thick otorrhea from the left ear. The patient had received only acetaminophen for the pain. His medical history was positive only for hyperopia and attention-deficit/hyperactivity disorder, and he was fully up-to-date with immunizations.

The physical examination showed vital signs within the normal ranges. The patient denied pain during passive traction to the left pinna. A sample of the discharge was sent for culture and identification. Otoscopy examination showed a foul-smelling yellowish discharge in the left ear canal, without erythema of the canal walls, and a minuscule puncture on a mildly erythematous tympanic membrane. The external ear was later examined using a Wood lamp (Figure).

What is the most likely diagnosis?
A. Uncomplicated acute otitis externa
B. Acute otitis media (AOM)
C. AOM due to Pseudomonas aeruginosa with tympanic perforation
 

ANSWER ON NEXT PAGE.