Case 3: A 10 year old child complained of a right
mucopurulent otorhea for the last 2 years. He suddenly became feverish and this
was associated with diminution of the ear discharge. There was also tenderness
on pressure behind the auricle. The retroauricular sulcus was preserved. There
was no retroauricular fluctuation.
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CASE
3
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Diagnosis
& reasons
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Right
chronic suppurative otitis media (mucopurulent discharge of 2 years duration)
complicated by mastoiditis (fever with decreased ear discharge, tenderness
behind the auricle with preservation of retroauricular sulcus; it is not an
abscess because there is no retroauricular fluctuation).
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Explain
the following manifestations
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Diminution
of ear discharge: reservoir sign dischrge decreases but is still there
and whenever discharge decreases fever and other constitutional symptoms
increase in intensity
Tenderness
behind the auricle: due to inflammation of the bone of the mastoid
process and its overlying periosteum
Retroauricular
sulcus preserve: as the inflammatory process is subperioteal
No
retroauricular fluctuation: it is mastoiditis and so is not a mastoid
abscess yet
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Further
examination &/or investigations
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Treatment
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Medical
treatment in the form of antibiotics and
Drainage
of the ear through myringotomy and
Mastoidectomy
is essential to remove all disease from the ear
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Case 4: A 9 year old child has been
complaining of right continuous offensive ear discharge for the last 3 years. A
month ago he began to suffer from headache, fever and some vomiting for which
he received symptomatic treatment. The patient’s condition was stable for a
while, then after 2 weeks he started to suffer from severe headache and
drowsiness. The patient also noticed difficulty going up and down the stairs. A
week later, he developed weakness in the left arm and left leg, and became
markedly drowsy. He became comatose the next day.
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