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Invasive fungal otitis media with peripheral facial paralysis

Summary

This case describes a rare fungal ear infection caused by Aspergillus fumigatus that spread to the mastoid bone and caused facial nerve paralysis. The patient had ear drainage and hearing loss for 4 years before diagnosis. Treatment required two surgical procedures to remove infected tissue combined with 6 months of antifungal medication, eventually resulting in healing and recovery of facial nerve function.

Background

Invasive fungal otitis media is a rare clinical condition that often presents with atypical symptoms and can be misdiagnosed as chronic suppurative or tuberculous otitis media. Risk factors include diabetes, glucocorticoids, tuberculosis, and immunosuppressants. The condition can progress to serious complications such as meningitis and intracranial granuloma formation.

Objective

To report a case of invasive Aspergillus fumigatus otitis media complicated by mastoiditis and peripheral facial paralysis, and to discuss the diagnosis, treatment, and management of this rare condition.

Results

Histopathology and culture confirmed Aspergillus fumigatus infection. Initial surgery was followed by recurrence requiring a second mastoidectomy on day 197. The patient developed peripheral facial paralysis (House-Brackmann IV) 20 days after the second surgery. Treatment with dexamethasone, vitamin B12, and 6 months of voriconazole (200-150 mg orally twice daily) resulted in recovery of facial nerve function to House-Brackmann II and complete epithelialization of the surgical cavity by day 287.

Conclusion

Invasive fungal otitis media requires complete surgical removal of lesions combined with prolonged antifungal therapy based on drug sensitivity testing. Peripheral facial paralysis during treatment is a dangerous signal of invasive fungal infection. Early recognition and aggressive combined surgical and medical management are essential for successful outcomes.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 39398287, DOI: 10.1016/j.mmcr.2024.100672
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