Case 13-1999

Abstract

A 20-year-old woman was admitted to the hospital because of chronic right otitis media.The patient had been well until one year earlier, when a "bad cold" developed, with a sore throat. The sore throat subsided after one week, but nasal congestion and the sensation that her ears were blocked persisted for a month. A physician made a diagnosis of sinusitis and prescribed a nasal spray and an unknown antibiotic. The left ear became clear, but the right ear remained symptomatic. Treatment with trimethoprim-sulfamethoxazole provoked a rash and was discontinued, and a third antibiotic was ineffective. Painless drainage from the right ear developed, with diminished hearing. An audiometric examination revealed loss of conductive hearing in the right ear. The patient had a purulent nasal discharge and postnasal drip during the rest of the year. Three months before admission, a computed tomographic (CT) scan of the temporal bones ( Fig. 1) showed opacification of the right middle ear and mastoid bone, without erosion of the scutum, ossicular chain, or otic capsule. The external canal, the contour of the posterior nasopharynx, and the visible portions of the paranasal sinuses appeared normal. Insertion of a tympanostomy tube did not improve hearing and was followed by a perforation that involved 30 percent of the eardrum.Evaluation of the patient at the Massachusetts Eye and Ear Infirmary a month before admission revealed a perforation in the inferior portion of the right tympanic membrane. Inspissated white material that filled the middle ear appeared to be solid granulation tissue.