SCIENTIFIC
Acute Otitis Media and Mastoiditis with Post-Auricular Abscess in a Five-Week-Old
AUTHORS :
Tyler Wanstreet , BS West Virginia University School of Medicine
Marcus Shaffer , MD CAMC Pediatric ENT , CAMC Women and Children ' s Hospital
CASE PRESENTATION
A previously healthy five-week-old boy presented to the emergency department following a visit at an urgent care facility . The infant was in a normal state of health in the morning according to the mother . Around noon , the mother noticed that the patient ’ s right ear lobe was protruding and stated there was erythema and edema behind it . The patient had been fussy over the past two weeks but consolable with good oral intake and urine output with no fevers or trauma .
ABSTRACT
CT of the internal auditory canal with contrast obtained on the following day revealed right mastoid effusion and otitis media with breech of temporal bone cortex overlying the right mastoid air cells
Mastoiditis and post-auricular abscesses are exceptionally rare complications of acute otitis media in children less than six months of age . We report the case of a five-week-old boy who presented with protrusion of the right ear accompanied by surrounding erythema and edema . Head computed tomography ( CT ) revealed right acute otitis media with mastoid opacification and possible post-auricular abscess formation . After one day of intravenous antibiotics and corticosteroids , repeat head CT with contrast revealed right mastoid effusion , breech of the temporal bone cortex overlying the right mastoid air cells , and abscess formation . The disease course and treatment are described .
and fluid extending into the soft tissues consistent with an abscess ( Figure 2 ).
The antibiotic regime was changed to IV ceftriaxone 150mg q12hr , 75mg / kg / day ,
FIGURE 1 : Computed tomography scan reveals right otitis media and mastoid opacification extending into the post-auricular soft tissues ( yellow arrow ).
Physical examination revealed a protruding right ear lobe and post-auricular swelling and erythema . Head computed tomography ( CT ) revealed right acute otitis media ( AOM ) and mastoid opacification extending into the post-auricular soft tissues with possible ear abscess formation ( Figure 1 ). The child was admitted to the hospital with the following findings : temporal artery temperature = 37.0 ° C , peripheral pulse = 150 beats per minute , respiratory rate = 36 breathes per minute , blood pressure = 116 / 83 mmHg , pulse oximetry = 100 %, hemoglobin = 11.9 g / dL , white blood cell = 17.6 x 10^9 / L , Platelet count = 790,000 per mcL , Lactic acid = 4.0 mg / dL , and C-reactive protein = 27.7 mg / L . Basic metabolic panel was within normal limits .
Intravenous ( IV ) vancomycin 15 mg / kg q6hr ( day 1 and 2 ), IV dexamethasone 0.5 mg / kg q8hr , and dextrose 5 % in water with ¼ normal saline and 10 milliequivalents of potassium chloride ( D5W ¼ NS with 10KCL ) at 16 mL / hr maintenance intravenous fluids ( MIVF ) were administered . A blood culture was obtained . The patient ’ s condition improved overnight .
30 • www . wvsma . org