Otomastoiditis Revealing an Occult Textile Foreign Body in a 5-Year-Old Child: A Case Report of a Diagnostic Pitfall

Abstract

Aim: Foreign body-related otomastoiditis is uncommon in children and may be difficult to diagnose when the inserted material is non-metallic, unwitnessed, and concealed by inflammatory tissue. This report describes an occult textile foreign body presenting as refractory otomastoiditis in a 5-year-old immunocompetent child. Case Presentation: A 5-year-old girl presented with left otalgia, purulent otorrhoea, fever of 39 °C, postauricular swelling, and auricular protrusion after failing to improve with topical ofloxacin. Otoscopy was limited by canal stenosis and subsequently revealed an inflammatory external auditory canal polyp. Temporal computed tomography demonstrated otomastoiditis extending to the middle ear and a 40 mm subperiosteal abscess overlying the left mastoid. Cytological and bacteriological examination identified no organisms, and culture was negative. Despite 10 days of intravenous amoxicillin-clavulanic acid and ceftriaxone with topical ofloxacin, otorrhoea and the canal polyp persisted. Mastoidectomy with attico-antrostomy and excision of the polyp revealed granulomatous inflammation surrounding a textile foreign body. The foreign body was removed, oral amoxicillin-clavulanate was continued for 8 days, and complete clinical recovery was observed. At one-month follow-up, otoscopy showed resolution of the polyp. Conclusion: In children with otomastoiditis that does not resolve with appropriate antibiotic therapy, an occult aural foreign body should be considered. Surgical exploration may be necessary when non-metallic material is not identified on imaging and persistent inflammatory findings remain.