A 3-year-old boy presented with pain in the right ear and swelling in the postauricular area that had begun 3 days earlier. His father reported that the boy had had a whitish discharge from his right ear 8 days earlier, for which a pediatrician had prescribed antibiotic eardrops. The patient had no fever or leukocytosis. On physical examination, the swollen postauricular area was fluctuant and tender (Panel A), and white secretions were observed in the external auditory canal.
A computed tomographic scan of the temporal bone (Panels B and C) showed a hypointense cystic fluid collection (yellow arrows) with adjacent inflammation (green arrows) in the perimastoid area. There was no evidence of an infectious process in the middle ear or mastoid area. The patient was taken to the operating room, where examination of the right external auditory canal revealed a small fistula track, which…
