A man in his 30s presented to an outside emergency department with left-sided otalgia and periauricular swelling. He was discharged after being prescribed oral antibiotics but continued to have worsening symptoms and returned to the outside facility, where a noncontrasted computed tomographic (CT) scan of the neck and chest showed significant subcutaneous emphysema of the neck and mediastinum (Figure, A and B). He was subsequently transferred to our facility for additional treatment.