PANCE Blueprint EENT (7%)

10 y/o with ear pain worsening over the last 5 days (view on ReelDx)

Patient will present as → a 10-year-old boy with otalgia, worsening over the last 5-days and associated with nasal congestion. The patient is afebrile with a temperature of 98 ° F. Examination reveals edema of the external auditory canal producing an anterior and inferior displacement of the auricle with percussion tenderness posteriorly. 

Acute mastoiditis is a suppurative infection of the mastoid air cells, usually a complication from preceding acute otitis media

• Clinical features include fever, otalgia, pain and erythema posterior to the ear, and forward displacement of the external ear
• Organisms: S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus, S. pyogenes

History and physical exam. Most cases of mastoiditis can be clinically diagnosed

• CT scan of the temporal bone with contrast is the imaging of choice for complicated mastoiditis or toxic-appearing patients

IV antibiotic treatment is initiated immediately with a drug that provides central nervous system penetration, such as ceftriaxone 1 to 2 g once a day continued for ≥ 2 weeks

• Vancomycin or linezolid are alternatives
• Oral treatment with a quinolone may be acceptable in certain cases
• A subperiosteal abscess usually requires a simple mastoidectomy, in which the abscess is drained, the infected mastoid cells are removed