Case 1: Otorrhea, Otalgia, and Blurry Vision in an 11-year-old Girl

Douglas Shapiro; Danish Vaiyani; Drew Horlbeck; Steven Pattishall

doi:10.1542/pir.2016-0091

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Douglas Shapiro, MD*,^†
Danish Vaiyani, MD*,^†
Drew Horlbeck, MD*,^‡
Steven Pattishall, MD*,^‡

^*Wolfson Children's Hospital, Jacksonville, FL
^†University of Florida College of Medicine, Jacksonville, FL
^‡Nemours Children's Specialty Care, Jacksonville, FL

AUTHOR DISCLOSURE
Drs Shapiro, Vaiyani, Horlbeck, and Pattishall have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

An 11-year-old girl presents to the emergency department with right-sided otorrhea, otalgia, and blurry vision. Otorrhea started 4 weeks ago while at swimming camp. This persisted, and she then developed otalgia and headache. One week ago, her pediatrician prescribed ciprofloxacin-dexamethasone otic drops for presumed otitis externa. Her symptoms continued to worsen, and yesterday she developed double vision. At a follow-up visit today her pediatrician advised her to be evaluated in the emergency department. She denies fever, trauma, tinnitus, dizziness, and weight loss.

On physical examination, her temperature is 98.4°F (36.9°C), heart rate is 68 beats/min, blood pressure is 119/78 mm Hg, and respiratory rate is 16 breaths/min. She is a healthy-appearing girl in no distress. The right external ear canal is filled with purulent material without a foreign body, and the tympanic membrane is not visualized. The left ear canal and tympanic membrane are normal. There is no mastoid tenderness, swelling, or erythema. Pupils are equal and reactive to light and accommodation. Her right eye is unable to abduct beyond midline. She demonstrates binocular diplopia. There is no nystagmus or pain with …