What other primary problems are present in this case?

Primary Problems Present in This Case

Otomastoiditis with Potential Complications

This case presents acute otomastoiditis as the primary problem, which requires immediate aggressive treatment with IV antibiotics and close monitoring for life-threatening intracranial complications. 1

Core Clinical Problem

• Otomastoiditis is a serious complication of acute otitis media requiring prompt intervention to prevent intracranial spread 1
• The condition manifests with ear pain, fullness, and typically purulent drainage, representing bacterial extension from the middle ear into the mastoid air cells 2, 1
• This is a medical emergency requiring immediate IV broad-spectrum antibiotic therapy 1

Associated Otologic Problems

• Acute otitis media is the underlying primary infection that has progressed to involve the mastoid 2, 1
• Persistent middle ear effusion is expected and common, with 60-70% of patients having effusion 2 weeks after treatment 1
• Conductive hearing loss from middle ear and mastoid involvement requires audiologic assessment if effusion persists ≥3 months 1

Potential Immunologic Problems

• Possible underlying immunodeficiency should be considered if this represents recurrent or refractory infection 3
• Recurrent otitis media with mastoiditis progression may indicate humoral immunodeficiency, particularly selective IgA deficiency or common variable immunodeficiency 3
• Quantitative immunoglobulins (IgG, IgA, IgM) should be obtained if the patient has a history of recurrent infections 3

High-Risk Complications Requiring Surveillance

• Intracranial complications including brain abscess (most common), meningitis, subdural empyema, and sigmoid sinus thrombosis 1
• Sigmoid sinus thrombosis is particularly concerning in children with mastoiditis and requires CT venography or MR venography if suspected 1
• No reliable clinical signs distinguish patients with coexistent intracranial complications, making imaging crucial in non-resolving cases 1
• Neurological deterioration including altered consciousness, seizures, focal deficits, or nuchal rigidity indicates intracranial extension 1

Dental and Sinus Problems (If Maxillary Involvement)

• Dental root infection can erode through bone into the maxillary sinus, causing secondary sinusitis that may present with dental pain 2
• The roots of teeth project into the floor of the maxillary sinus, creating potential for bidirectional spread of infection 2

Communication and Diagnostic Challenges

• Delayed diagnosis risk is substantial, as ear fullness and blockage are common non-specific symptoms that may not prompt urgent evaluation 2, 4
• Poor communication between secondary and primary care represents a systemic problem that can delay appropriate treatment 4
• Atypical or non-specific presentations increase the risk of diagnostic error in primary care settings 5

Psychological Impact

• Anxiety and depression from sudden hearing loss and persistent tinnitus require psychological support 2
• The nearly universal accompanying tinnitus in sudden hearing loss intensely contributes to patient distress 2