HSC Section 8_April 2017

A. E. TARAZI ET AL.

FIG. 1. Axial computed tomographic scan shows soft tissue attenuation of the right mastoid and right middle ear, with suspected mild erosive changes of the anterior wall of the external auditory canal.

FIG. 3. Technetium scan showing intense uptake within the right cranial base, mainly within the temporal bone and involving the right mastoid and the petrous temporal region.

been treated with multiple courses of oral and local anti- biotics, including quinolones. Examination of the right ear revealed sagging of the superior canal wall and a thickened tympanic membrane with polypoid changes in the mesotympanum. There was mucoid yellowish discharge in the canal as well. Swab culture from the right ear showed soft tissue attenuation of the right mastoid and right middle ear, with suspected mild erosive changes of the anterior wall of the external auditory canal (Fig. 1). There was mild enhance- ment of the right side of the nasopharynx and right para-

pharyngeal space with partial involvement of the masticator space (Fig. 2). There was dense attenuation of the right mastoid and right middle ear, including suspected mild erosive changes of the anterior wall of the external au- ditory canal (Fig. 2). Technetium and gallium scans showed intense uptake within the right cranial base, mainly within the temporal bone and involving the right mastoid and the petrous tem- poral region (Figs. 3 and 4). The patient began receiving intravenous administration of ciprofloxacin 400 mg every 12 hours and ceftazidime 2 g every 12 hours. However, he did not respond to therapy, and his erythrocyte sedimentation rate rose to 117 mm/h. A right-sided myringotomy with tube placement was per- formed. The aspirate from the middle ear grew Aspergillus species. The patient was then intravenously administered amphotericin B lipid complex 400 mg once daily, but he developed fever, chills, and severe rigors. The medication was changed to intravenous administration of voricona- zole 300 mg every 12 hours. One week later, the patient was pain free, and his erythrocyte sedimentation rate (ESR)

FIG. 2. Axial computed tomographic scan shows mild enhance- ment of the right side of the nasopharynx and right parapharyngeal space with partial involvement of the masticator space.

FIG. 4. Gallium scan showing intense uptake within the right cranial base, mainly within the temporal bone and involving the right mastoid and the petrous temporal region.

Otology & Neurotology, Vol. 33, No. 5, 2012

95