PANCE Blueprint EENT (7%)

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 & 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

For simple mastoiditis, oral antibiotic treatment should cover the most common pathogens (strep pneumo, strep pyogenes, and staph aureus)

• Consider IV antibiotics and ENT referral in more serious cases or with patients with unreliable follow-up
• Drainage by procedures such as tympanocentesis or myringotomy may also be considered