Explaining mastoiditis, admission and the surgical decision — OSCE

Candidate instructions (8-minute station)

You are the paediatric registrar in the emergency department. A 14-month-old has three days of fever, coryza and ear-pulling, started on oral amoxicillin yesterday for acute otitis media. Today the child is more unsettled and febrile, with right postauricular erythema, swelling and tenderness, a lost postauricular crease, the pinna pushed downward and outward, and a bulging erythematous tympanic membrane. The parent is anxious and wants to know whether the ear is serious, whether the antibiotic syrup is enough, whether the child needs to stay in hospital, and whether an operation is needed. ^[4]

Your tasks are: ^[4]

1. Explain the diagnosis of acute mastoiditis in plain language and why it is more than a simple ear infection. ^[4]
2. Explain why the child needs admission and intravenous antibiotics rather than oral syrup, and outline the plan for a myringotomy and the 48-hour reassessment. ^[8]
3. Explain the possible need for a scan and for surgery, including the cortical mastoidectomy, and the 48-hour decision point. ^{[8] [5]}
4. Give a clear, specific safety-net for the signs that would mean the infection has spread towards the brain and needs urgent escalation. ^[1]

You are not expected to prescribe the intravenous regimen in detail to the parent, but you should explain the plan clearly and honestly, including the possibility of an operation. ^[5]