A 4 year old has earache and fever. Has taken paracetamol several times. Now it’s noticed that he increases the TV volume. His preschool hearing test shows symmetric loss of 40db. What is the most likely diagnosis?

The key is B. Otitis externa. [Otitis media with effusion does not present with earache and fever. The patient has otitis media with effusion from before but currently he has developed earache and fever and this is due to otitis externa. Please note diagnosis is made for recent complaints though other disease may co-exist!]