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Otomastoiditis with postauricular abscess - post-operative

Case contributed by Ryan Thibodeau
Diagnosis certain

Presentation

Right ear protruding forward with erythema, swelling, and tenderness.

Patient Data

Age: 11 years
Gender: Female

There is a large fluid collection with air-fluid level in the postauricular soft tissues measuring approximately 4.3 x 2.7 cm. The collection is continuous with the mastoid process. There is complete opacification of the mastoidectomy bowl and dehiscence of the cortex in connection with the soft tissue fluid collection. There is soft tissue thickening and essentially complete occlusion of the external auditory canal. There is associated dehiscence of the posterior wall of the external auditory canal with connection to the mastoid and middle ear cavity. There is demineralization of the body, lentiform process, and long process of the incus. The otic capsule is well mineralized.

There is evidence for prior operative changes related to a right canal wall down mastoidectomy and a left canal wall up mastoidectomy. There is a cochlear implant on the left with the implant lead well positioned within the cochlea. The mastoidectomy bowl and remaining left mastoid air cells are well aerated. The left middle air cavity is well aerated.

Case Discussion

This is a case of otomastoiditis with a soft tissue postauricular abscess. The patient was admitted to the hospital and ENT was consulted for incision and drainage of the abscess. Cultures grew extended spectrum extended spectrum beta-lactamase (ESBL) E. coli, Enterococcus avium, and Trueperella bernardi. The ESBL E. coli was not susceptible to any oral agents, so the patient received a PICC and was discharged home on IV meropenem. After completing her course, there were no clinical concerns of recurrence of the infection at an outpatient visit.

The patient had a prior cochlear implant on the right but the patient experienced recurrent infections in this area. Due to concern for an infected right cochlear implant, she underwent a right cochlear explantation. Despite this, however, she continued to have recurrent infections.

Co-author:
Travis Bevington, MD

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