Bell’s Palsy in Children Case 2

A 9-year-old boy presents to the ED with his father with a history of being unwell for the last 9 days. Last night his father noted a right-sided facial droop. On further enquiry the father reveals that the child has had a thick yellow discharge from his right ear for the last 9 days. Over the last 48 hours the child has complained of an increasing headache and has vomited three times during the night and once the previous night. The boy was seen by the family GP approximately 5 days ago and a viral ear infection was diagnosed. He was due to see his GP again.

The father denies any history of trauma. The boy takes no regular medication and has no known allergies. No relevant family history was elicited.

How would you assess this child if he presented to you in the ED?

On examination he is found to have a temperature of 38.5^o, a purulent discharge from his right ear, a unilateral lower motor neurone type facial paralysis to the right side and evidence of papilloedema on fundoscopy.

Suggest a differential diagnosis for this patient.

How would you manage this patient?

Select the statements which are true.