Case contributed by Dachani Kansan Naider


Left otitis externa with cellulitis for 3 days and now, has tenderness on mastoid region. CT was performed to evaluate presence of mastoiditis.

Patient Data

Age: 40 years
Gender: Male

Petrous temporal bones

  • soft tissue thickening within the left external auditory canal

  • mild thickening of left tympanic membrane

  • the external auditory canal is patent

  • some fat stranding in the region of the left pinna

  • no destructive bony changes on the left side. The left mastoid air cells and left middle ear chamber demonstrate normal aeration

  • minor non-specific opacification in the right mastoid air cells

  • pneumoparotid noted bilaterally; multiple small gas locules seen within both parotid glands and ducts

Case Discussion

The CT scan demonstrated features consistent with the patient's presentation of left otitis externa and surrounding cellulitis. There was no CT evidence of left mastoiditis as queried by the clinician.

However, there was an incidental finding of bilateral pneumoparotid. This is not related to the inflammatory changes on the left side of the face as the pneumoparotid changes are seen bilaterally.

Pneumoparotid is rare; nevertheless, it is associated with elevated oral positive pressures such as in glassblowers, underwater divers and Valsalva maneuver. 

On further history-taking, it was noted that this patient performs Valsalva to pop his ears multiple times a day.

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