An 8-month-old previously healthy boy presents to the ED with fever and nystagmus. He has been having cough, congestion, and rhinorrhea for about 1 week. Over the past 2 days, he has been persistently febrile despite antipyretics. Today in his pediatrician's office, he was diagnosed with bilateral acute otitis media (AOM). However, the physician noted horizontal nystagmus in the child and sent him to the ED for further evaluation.

Physical examination reveals a well-appearing, interactive, fair-skinned boy who has light, cream-colored hair. He has bilateral otitis media with profuse otorrhea. Complete neurologic evaluation yields normal results with the exception of intermittent, right-sided, jerky nystagmus.

Initial laboratory results show a normal CBC and serum electrolyte concentrations. A CSF examination does not show any evidence of infection, and a head CT scan demonstrates bilateral middle ear and mastoid effusions but no acute intracranial process. An EEG is read as normal. The patient...

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