Mastoiditis: a strange looking ear
Test your understanding with our picture quiz
An 18 month old boy was brought to the emergency department by his mother as she was concerned about his right ear, which was protruding and had started to displace downwards (figure). The ear had been protruding for the past few months, but recently she had also noticed a red swelling developing behind the right ear. A few months before presentation he had had no problems with his ears. He was afebrile and otherwise well. The opinion of a senior ear, nose, and throat doctor was sought, and urgent computed tomography showed an area of opacity within the mastoid cortex.
1) What is the differential diagnosis?
2) How should you investigate this patient?