A 12-year-old presents with itching in the ear and pain when the pinna is pulled or the tragus moved, with redness in the ear canal and a clear odorless fluid. This is most consistent with which condition?

A 12-year-old presents with itching in the ear and pain when the pinna is pulled or the tragus moved, with redness in the ear canal and a clear odorless fluid. This is most consistent with which condition?

• A. Right otitis media.
• B. Otitis externa.
• C. Mastoiditis.
• D. A ruptured tympanic membrane.

Answer: (B)

This presentation points to otitis externa, an infection and inflammation of the external auditory canal. The itching together with pain that worsens when the pinna is pulled or the tragus is moved is highly characteristic of canal inflammation. Redness of the ear canal and a clear, odorless discharge fit with inflammation of the outer ear rather than the middle ear. In otitis externa, the problem is in the ear canal itself, so there aren’t signs of middle-ear disease such as a bulging tympanic membrane or fever-driven middle-ear symptoms. By contrast, a ruptured tympanic membrane would typically cause sudden relief of pain after perforation and a discharge from the middle ear, not simply canal redness and tragus/pinna tenderness. Mastoiditis would present with post-auricular tenderness or swelling and more systemic signs, reflecting extension from the middle ear.

This presentation points to otitis externa, an infection and inflammation of the external auditory canal. The itching together with pain that worsens when the pinna is pulled or the tragus is moved is highly characteristic of canal inflammation. Redness of the ear canal and a clear, odorless discharge fit with inflammation of the outer ear rather than the middle ear. In otitis externa, the problem is in the ear canal itself, so there aren’t signs of middle-ear disease such as a bulging tympanic membrane or fever-driven middle-ear symptoms. By contrast, a ruptured tympanic membrane would typically cause sudden relief of pain after perforation and a discharge from the middle ear, not simply canal redness and tragus/pinna tenderness. Mastoiditis would present with post-auricular tenderness or swelling and more systemic signs, reflecting extension from the middle ear.