A twenty-six-month-old boy presented in the clinic with recurrent bilateral ear discharge of sixteen months durations. Symptoms began sixteen months before presentation with left ear discharge and a few weeks later, the right ear began to discharge. The discharge from the left ear was copious, foul-smelling, and yellowish. There was a preceding fever, diarrhoea, and vomiting five days before the onset of ear discharge. There was no evidence of hearing loss. The mother claimed that the child responded to calls and instructions appropriately. There was recurrent nasal discharge, mouth breathing, nasal itching, and occasional snoring. There was itching, watering, and redness of both eyes, occasional lower lid swelling, and cough. He was treated at a Teaching Hospital in Nigeria with daily aural toileting, and dressing and has had various antibiotics, the names of which were unknown. The patient had repair of Tetralogy of Fallot (the ears were not discharging at the time of operation) in India four months before presentation. No history of sickle cell disease in the family. The mother started ante-natal care at a gestational age of four months. She was treated for malaria with Artemisin/lumefantrin four tablets twice daily for three days at the gestational age of four and eight months respectively.

Examination showed a young boy, who was not pale, anicteric, and afebrile. There was copious mucopurulent discharge in the right auditory canal. The right tympanic membrane could not be visualized due to the discharge. The left auditory canal was clear, the tympanic membrane was dull and there was a central perforation. He obeyed instructions at normal speech tone and intensity. There were slightly hypoplastic ala nasi bilaterally. The nostrils were patent. The turbinates were not engorged. There were hyperaemic tonsils bilaterally in the oral cavity and discrete submandibular lymph nodes bilaterally. The eyelids were oedematous bilaterally and the conjunctivae of both eyes were red. A provisional diagnosis of bilateral chronic active(suppurative) Otitis media, associated with Tonsillitis, Allergic Rhinitis, and allergic Conjunctivitis was made.

The diagnosis was explained to the mother and that possible complications include hearing loss, cholesteatoma or granulation tissue formation, facial paralysis, speech problems, educational problems, attention problems, valvular heart disease, impaired vision and problems with social adaptation. The boy would have to be properly treated to avoid these problems in the future. Ear swabs for microscopy, culture and sensitivity, full blood count, and x-ray of the post-nasal space were requested. Then, the patient was commenced on aural toileting twice daily, daily dressing of the right ear with Otomed (polymyxin B, neomycin/hydrocortisone) ear drops for 10 days, Actifed (triprolidine/pseudoephedrine) syrup 2.5mls twice daily for three days, amoxicillin/clavulanic acid 228mg twice daily and ascorbic acid 100mg daily for 7 days. When seen in the clinic two weeks later, ear discharge had ceased. Full blood count was normal. Ear swab for microscopy culture and sensitivity revealed Pseudomonas aeruginosa sensitive to amikacin. X-ray of the post-nasal space was essentially normal. He was to continue Otomed ear drops, ascorbic acid 100mg daily, triprolidine/pseudoephedrine syrup 2.5mls twice daily for 10 days. He was seen in the clinic 11 weeks later and the ear discharge had resolved. His mother complained that he had a cough, itching of the nostrils and watery rhinorrhoea. No nasal blockage and no difficulty in breathing. The right tympanic membrane was dull and intact. The turbinates were not engorged. An assessment of bilateral chronic active Otitis media, tonsillitis(resolving), allergic Rhinitis and allergic conjunctivitis (resolved)was made. The patient was placed on Otrivin(xylomethazoline) nasal drops 0.05% thrice daily, Actifed syrup 2.5mls twice daily and ascorbic acid syrup 100mg daily for seven days. He was to be followed up on an outpatient basis.