Clinical based medicine
In patients with chronic history of acute otitis media, that persist with symptoms like otalgia, lethargy, cervical tenderness, rhinorrea, dizzyness, vertigo,hypoacusia , there should be more investigation. nonetheless the physical examination should be in search of adenopathies, congestion of the tympanic membrane, changes of the external auditory canal, neurological signs, and misplacement of the ear.
One of the mayor complications of acute otitis media is mastoiditis, inflammation of the mastoid process, it causes fever in 81 % of cases, the association of otalgia, edema or erythema around the ear, perhaps displacement of the ear presents approximately in 98% (picture shown below ) It is also known as the Jaques sign. Otorreha in less than one fourth of patients, and fluctuations around the ear in 4.1%. The duration of symptoms previously mention last up to a week long.
When there is acute complications like the displacement of the ear, the patient must be check in to the hospital and star protocol for surgical intervention, other wise broad spectrum antibiotics should be started stat.