Updated 13 July 2015

Answer: What's your diagnosis? – Case 18

Mrs K and her 3-year-old son consulted their GP when the child developed a persistent fever. Based on the history and clinical findings, the young boy most likely has a middle ear infection.


Mrs K took her 3 year old son to the GP with a persistent fever. Read the full, puzzling case study here.

DiagnosisMiddle ear infections, which is common in young children.

It may start at any age and the symptoms are not always the same.

Most often a mother will visit the doctor when the child has a high fever that doesn't respond to fever medication. The child often looks ill, feeds poorly, is irritated and may have preceding flu-like symptoms.

Very young children can't tell you what's wrong with them, which means a thorough examination is very important (although oftten not easy!). In children who have a high fever the cause of the fever should always be carefully looked at.

Middle ear infections

Middle ear infections in children are common, especially between the ages of 2 and 4.

Anatomically the young child is more prone to develop middle ear infections as the eustachian tubes (connecting middle ear and throat) are shorter and the adenoids at the base of the eustachian tube often interfere with the opening of the tube when infections in the upper respiratory system occur, causing improper drainage and trapping of fluid in the middle ear.

Older children will complain about earache, but in young children one may not immediately know that middle ear infections are the cause of the persistent crying and fever. The young child may pull on his ear. The pain is also worsened by lying down.

Read: When to take earache to the doctor

What the doctor found:

Signs of a recent current upper respiratory tract infection, post nasal drip, irritated nasal mucosa and a cough. The eardrum was red and bulging and there was some fluid behind the eardrum.

If there is significant pressure build-up, the eardrum might rupture and a discharge may be present in the ear canal. When an ear drum ruptures the child will experience relief as the pressure behind the eardrum is usually the cause of the pain.

Treatment usually involves antibiotics. In some cases the middle ear infection may also clear up by itself. In persistent cases, an ear nose and throat specialist may consider placing grommets to prevent fluid build-up and eventually pressure build-up behind the eardrum.

NOTE: Health24's on-site GP Dr Owen Wiese reveals new cases on Thursdays. The answer is posted with the story on Mondays, or you can get it in our Daily Tip – sign up here.

Previously on What's Your Diagnosis?

What's your diagnosis - Case 1: vomiting and weight loss

What's your diagnosis - Case 2: eye pain

What's your diagnosis - Case 3: strange behaviour and a bullet in the back

What's your diagnosis - Case 4: seeing odd things

What's your diagnosis - Case 5: mysterious lungs

What's your diagnosis - Case 6: runner with seizures

What's your diagnosis - Case 7: swollen knee

What's your diagnosis - Case 8: bloody semen

What's your diagnosis - Case 9: confusing neurological signs

What's your diagnosis - Case 10: diabetic teenager with unusual signs and symptoms

What's your diagnosis - Case 11:bruising with no apparent cause

What's your diagnosis - Case 12: severe tummy pain

What's your diagnosis - Case 13: severe sore throat

What's your diagnosis - Case 14:abdominal pain and swelling

What's your diagnosis - Case 15: the world is spinning

What's your diagnosis - Case 16: numbness in forearm

What's your diagnosis? - Case 17: burning urine

Image: Doctor examining child's ear from Shutterstock


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