"Case files from the University of Florida: When an Earache is more than an Earache": A case report

We present a new series for the International Journal of Emergency Medicine, "Case Files from the University of Florida," in which we will present a case seen by the residents and faculty of the Emergency Medicine residency at the University of Florida, Gainesville, and have you, the reader, consider what the diagnostic possibilities are, determine what diagnostic tests are required, and "run" the case. We hope that these cases are educationally rewarding for you.PresentationInitial ManagementTreatment/ResuscitationDiagnosis/Disposition"When an earache is more than an earache"Patients with otitis media and related conditions present nearly 2 million times to the emergency department every year. The vast majority of these are benign in nature, and the treatment simply observation versus antibiotic therapy. There are occasions, however, where the simple earache turns into something much more. We present such a case.A 5-year-old child presented to the University of Florida Emergency Department (ED), brought by the mother, with complaints of earache, vomiting, and fever for 3 weeks. The mother had brought the child to their pediatrician the previous week, and he was subsequently diagnosed with dehydration. The parents also brought the child to another emergency department later in the week, and she stated the patient was given intravenous fluids for dehydration. He was discharged home, and his parents given instructions to give acetaminophen for fever and to continue oral rehydration. On this second ED presentation, the mother stated the child was tolerating oral liquids, had urinated once that a.m., and his last bowel movement had been the previous day. The stool was normal in consistency and not bloody. The maximum temperature the patient had was 102°F. The patient had vomited two times on the day of presentation, and it consisted of previously eaten food with no blood. Further history revealed that the child did not attend daycare, there were no smokers in the househ