Otitis externa — structured clinical encounter

An eight-year-old girl who swims daily presents with two days of worsening right ear pain, a mucky discharge and itching, crying when the ear is touched. Pressing the tragus and pulling the pinna backwards reproduce her pain, the canal is swollen and red with yellowish debris, and once a small amount is cleared the eardrum looks normal; she is afebrile and well. You are the paediatric registrar working through the canal-versus-middle-ear distinction, the analgesia-led topical-first management and the ear wick, with a later scenario of an immunocompromised six-year-old with severe unremitting otalgia, granulation at the bony-cartilaginous junction and a facial palsy.