AN 8-MONTH-OLD male without a history of illness was brought to the emergency department with a 1-day history of left postauricular swelling, erythema, tenderness, ear tugging, and fever (maximum temperature, 39.4°C). The patient had had an upper respiratory tract infection the month before with clear rhinorrhea, poor feeding, irritability, and cough. The mother denied previous otologic problems. The infant was a full-term, vaginally delivered neonate with normal Apgar scores. The prenatal and perinatal history were unremarkable.
On physical examination, the patient was an illappearing, somewhat lethargic but arousable infant. The patient's temperature was 39.4°C, with a heart rate of 143 beats per minute. The left auricle was lateralized, and the postauricular area was swollen, erythematous, and warm (Figure 1). No fluctuation or induration was appreciated. Pneumatic otoscopy revealed a dull, violaceous tympanic membrane with decreased mobility. The right tympanic membrane was also retracted and dull with reduced mobility. Findings from