A 62 years old man was referred to our department experiencing right otalgia, purulent otorrhea, ear loss and a grade III right facial nerve palsy according to the House Brackmann scale. He was affected by decompensated insulin-dependent type 2 Diabetes. The patient had a history of non cholesteatomatous ipsilateral chronic otitis treated with tympano-mastoid surgery 10 years before, without any sign of recurrence.
At the examination there was a purulent discharge from the right ear, the canal appeared red and swollen, the tympanic membrane was not visible and the retro auricular and preauricular areas showed redness and swelling. Meningeal signs were negative, without any cervical lymphadenopathy or any alteration of the blood exams. CT scan showed opacification of the right middle ear and mastoid cavity, with osteolysis of the facial canal and of the tegmen tympani, while MRI with contrast showed a mild enhancement in the meninx.
The scintigrafic evaluation with 99-Technetium confirmed the osteomyelitis with increased uptake of radio-marked Difosfonatein the temporomandibular joint, mastoid cells, semicircular canals, cochlea, middle and inner ear and in the greater wing of the sphenoid bone.
No comments:
Post a Comment