Presentation
Purulent right ear discharge with headache, nausea, and vertigo. Prior history of operated cholesteatoma on the right. Intracranial abscess?
Patient Data
Bilateral mastoid air cell hypoplasia and opacification. On the symptomatic right side the middle ear is also opacified, but as much as it can be appreciated on a standard head CT the ossicular chain appears normal. No pathological enhancement after iv. contrast, incidental right frontal DVA noted.
Altogether findings are highly suggestive of otitis media on the right.
Follow-up MRI after antibiotic therapy to differentiate potential underlying cholesteatoma.
Partial fluid signal filling the right tympanic cavity and mastoid air cells but no findings indicative of cholesteatoma.
Case Discussion
The case demonstrates that otitis media can present with minimal morphological changes on imaging, and that these have to be correlated clinically to provide a correct interpretation.
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