A 19-year-old college student presented to the university health clinic with a 3-day history of pain and whitish drainage from his left ear. He had gone swimming before the onset of symptoms, and neither of his two roommates had similar symptoms. The patient had no history of ear infection or ear surgery. He denied hearing loss, vertigo, or aural fullness and did not use tobacco, alcohol, or illicit drugs. He was not actively taking any medications and had no drug allergies.
On examination, the patient appeared comfortable, and his vital signs were all within normal limits. Fundoscopy and anterior rhinoscopy were unremarkable. The patient reported substantial pain when the left auricle was manipulated and when the aural speculum was placed in the left ear canal. The left mastoid process was non-tender. Otoscopy of the left ear demonstrated significant swelling of the external auditory canal with a small amount of thin white fluid. The tympanic membrane was poorly visualized but appeared to be intact. The right ear was normal on examination. The patient’s oral cavity and oropharyngeal cavity were also unremarkable, with no pain around the temporomandibular joints when opening or closing the mouth. The neck was supple without lymphadenopathy.
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