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A 5-Year-Old Boy Is Brought to the Clinic Due to Persistent

question 118

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A 5-year-old boy is brought to the clinic due to persistent ear discharge.  The patient began to have purulent right ear drainage a month ago.  Topical antibiotic drops and oral antibiotics have not improved his symptoms.  He has had no fever, ear pain, dizziness, or tinnitus.  The patient was born with a cleft palate that was repaired in infancy.  Due to bilateral persistent middle ear effusions, tympanostomy tubes were also placed.  Three years ago, the tympanostomy tubes were removed, after which audiometry was normal.  He has no other medical conditions.  Temperature is 37.2 C (99 F) .  There is scant, yellow, malodorous discharge in the right ear canal.  The right tympanic membrane (TM) is immobile with insufflation and appears intact.  There is retraction of the superior portion of the TM and a pearly white mass.  The left TM is mobile and normal in appearance.  Audiometry reveals conductive hearing loss on the right side.  Gait is normal.  Which of the following is most likely responsible for this patient's presentation?

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Definitions:

Intimacy

The close, familiar, and usually affectionate or loving personal relationship with another person or group.

Adolescent Friendships

Relationships between teenagers that play a critical role in their emotional and social development, often characterized by deep bonds, emotional support, and identity formation.

Interdependence

A mutual reliance among members of a group or system, where the actions of each individual can affect the whole.

Close Relationships

Emotional bonds between individuals characterized by affection, trust, and mutual support.

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