A 93-year-old man presented to the emergency department of our hospital with a 1.5-month history of severe otalgia and constant otorrhea on the right side. He had no previous history of otologic diseases, DM, or lung tuberculosis. Otoscopically, the bony part of the EAC was partly obstructed by massive fleshy granulations. Granulations were also observed in the tympanic cavity through the eardrum perforation. A blood test showed leukocytosis (18.2 x 109/L). S. aureus was isolated from the ear swab.
CT scan revealed an osteolytic lesion of the petrous apex of the temporal bone with loss of clear bony margins of the carotid foramen (Figure 7(a)). Radiologically destructive peritubal mastoiditis was diagnosed. Several bony sequestra were clearly seen on the CT scans. In this case, an infection extended directly through the defect in the anterior wall of the tympanic cavity into the surrounding spaces: mandibular fossa and temporomandibular joint (Figures 7(b) and 7(c)). Diffuse pericapsular inflammation of the latter with widened joint cavity was seen on the CT scans.
Clinically, a diagnosis of coalescent mastoiditis complicated by temporal bone osteomyelitis coexisting with necrotizing external otitis was made.
Due to the age and anesthetic risk, a conservative tactic was chosen with active removal of the granulations under local anesthesia. After the treatment, subjective improvement of otalgia and reduction of the granulations were observed. The patient was discharged from the hospital after one week. Long-term antibiotics (Cefuroxime 500 mg twice a day for four weeks) with local drops were prescribed according to the culture results.