6 year old boy presenting to the ED with fevers and left ear | Figure 1

jkaine
Emergency Medicine Resident

6 year old boy presenting to the ED with fevers and left ear pain. He was seen by his pediatrician 4 days ago and treated for an ear infection with oral antibiotics. He now is presenting to the ED with fever to 101F, drainage from the ear, and swelling. On exam he has swelling and erythema behind his left ear with yellow-white discharge from the canal. The TM is erythematous. What would be on your differential? What is the recommended workup? How would you treat?

63yo male with prediabetes and htn with 5 days of left ear swelling that moved to right ear and occiput. Fevers, chills, decreased hearing with right ear bloody drainage. Improved with iv vanc and clinda. Ct showed cellulitis snd myositis + sinus disease. What do you think the source is?

Fm 30 yrs old. Hx of whitish smelly discharge from left ear( 4years). Feels pressure and heaviness in right ear. Also has headache.
DDX: otitis media with effusion and pin point perforations. CT showed Chronic Mastoiditis in left ear with bilateral maxillary sinusitis. Various Antibiotics courses has been done but there has been no relief of symptoms.
PAST MEDICATION:
Ciprofloxacin (PO)
Ciprofloxacin+dexamethasone( ED)
Amoxycillin+ clavulunic acid (PO)
Serratiopeptidase(PO)
Loratadine (PO)
Clarithromycin (PO)

50 year old male patient, admitted with recent head injury to the face. Left ear pain and mastoid bruising from 5 days earlier noted. He gradually developed severe headache and worsening ear pain. He was brought with reduced GCS, fever and agitation. Empirically managed as meningoencephalitis. Non-contrast CT was reported normal. Contrast CT was performed to exclude cerebral abscess: Generalised sulcal effacement with mild generalised leptomeningeal enhancement, raising the possibility of meningoencephalitis. No intracranial abscess but there is suggestion of bilateral mastoiditis and left otitis media. Bloods shows CRP 250 and WCC 16. WHAT is the single most important lesson to be drawn from this narrative?