A 14-year-old girl reports several episodes of sudden-onset, intense vertigo lasting 1-2 minutes, associated with imbalance and nystagmus but no hearing loss or tinnitus. The episodes are not clearly linked to position changes but can occur spontaneously. She has a history of migraines, though not always associated with these vertiginous spells. What is the most likely diagnosis?
A 4-year-old boy is being examined for persistent middle ear fluid. During pneumatic otoscopy, the tympanic membrane is noted to be retracted. When positive pressure is applied, there is no visible inward movement. However, when negative pressure is applied by releasing the bulb, the tympanic membrane briskly moves outward. What do these findings most accurately indicate?
A healthy 18-month-old girl fails her newborn hearing screen and subsequent audiology testing confirms bilateral, severe-to-profound sensorineural hearing loss. There is no family history of hearing loss, and the pregnancy was uncomplicated. Genetic testing reveals that she is homozygous for the 35delG mutation (35delG/35delG genotype) in the GJB2 gene. How should the parents be counseled regarding her prognosis?
A 2-year-old child with acute otitis media has failed two courses of appropriate antibiotic therapy and continues to have high fever and a bulging, immobile tympanic membrane. The parents are concerned about his ongoing pain and illness. Under which of the following circumstances is tympanocentesis most clearly indicated?
A 15-month-old presents with irritability and a low-grade fever. On otoscopy, the right tympanic membrane is white and opacified with decreased mobility, but there is no bulging or marked redness. The parents do not report significant ear pain. Air-fluid levels are visible behind the tympanic membrane. What is the most accurate diagnosis for this child?
A 5-year-old with acute mastoiditis fails to improve after 48 hours of intravenous ceftriaxone. The child develops a new-onset headache and lethargy. The physical examination is now notable for right-sided facial weakness. What is the most appropriate next step in management?
A 9-month-old infant is brought to the clinic for a well-child check. The mother mentions that the infant has been irritable, sleeping poorly, and frequently pulls at his right ear for the past two days. He has a temperature of 38.3°C (101°F). What is the most likely source of his symptoms?
A 3-year-old is being evaluated for hearing concerns after a recent infection. A tympanogram performed on the right ear shows a flat tracing (Type B) with a recorded ear canal volume of 2.5 mL. What is the most likely interpretation of this tympanogram?
A mother of a 9-month-old infant asks for advice on preventing otitis media. She mentions that the child’s father smokes, the baby is formula-fed, and has two older siblings who attend school. Which of the following is an important, modifiable risk factor for otitis media in this infant?
A preterm infant in the neonatal intensive care unit (NICU) requires hearing screening. The infant has been treated with multiple courses of aminoglycosides and loop diuretics for sepsis and fluid overload. Considering the infant’s high-risk status and the NICU environment, what is the recommended hearing screening protocol?
