A 3-year-old boy presented with concern for acute coalescent mastoiditis. He had a history of bilateral myringotomy with tube insertion 9 months previously for recurrent otitis media. For the past month, he had persistent right-sided otorrhea that had not responded to oral or topical antibiotics. He presented with a noncontrast computed tomographic (CT) scan from his local emergency department (Figure, A and B). This showed right-sided mastoid and middle ear opacification, bony erosion of the mastoid, confluence of the air cells, and breach of the cortex. On examination, he was afebrile, healthy appearing, and energetic. He had purulent otorrhea in the right external auditory canal and very mild tenderness to palpation over the right mastoid tip. There was no ear proptosis, overlying erythema, fluctuance, or tenderness to auricle manipulation. Results from the cranial nerve examination (other than unreliable hearing assessment) were normal.
Robison JG, Otteson TD, Branstetter BF, Fowler JC, Chi DH. Chronic Right-sided Otorrhea. JAMA Otolaryngol Head Neck Surg. 2013;139(7):747-748. doi:10.1001/jamaoto.2013.3450