Right hemiparesis caused by massive otogenic brain abscess in children: Unusual case report and review of the literature

Bezold's abscess in tuberculous otitis media: An extremely rare case report and literature review

INTRODUCTION

Bezold's abscess is a rare complication of chronic suppurative otitis media since the advent of antibiotics. Otitis media can also result from uncommon infections such as tuberculosis, with a diagnosis often delayed due to clinical symptoms that closely resemble other chronic middle ear conditions.

CASE REPORT

We present a case of Bezold's abscess as a complication of primary tuberculous otitis media in a 21-year-old male who reported right-sided neck swelling for four days, accompanied by fever, difficulty opening his mouth, and a history of persistent purulent discharge in both ears for six months that did not respond to topical antibiotics.

DISCUSSION

This case underscores the diagnostic challenges of tuberculous otitis media, an unusual form of extrapulmonary tuberculosis that can closely mimic other types of chronic otitis media. The atypical presentation and low incidence of TOM contribute to frequent delays in diagnosis, highlighting the need for increased clinical vigilance, particularly in cases of persistent otorrhea unresponsive to standard antimicrobial therapy. Prompt recognition and initiation of appropriate antituberculous treatment, along with surgical intervention when indicated, are essential to prevent severe complications. This case illustrates the importance of considering TOM in the differential diagnosis of chronic ear infections and the value of advanced diagnostic modalities in facilitating early and accurate identification.

CONCLUSION

Tuberculous otitis media should be considered when optimal treatment regimens fail to achieve expected outcomes. Prompt diagnosis is essential in avoiding delays in treatment, which can lead to severe complications such as Bezold's abscess.

Potential otogenic complications caused by cholesteatoma of the contralateral ear in patients with otogenic abscess secondary to middle ear cholesteatoma of one ear: A case report

BACKGROUND

Otogenic brain abscess caused by middle ear cholesteatoma is a potentially serious and life-threatening complication in the ear, nose, and throat clinic. The mortality rate associated with otogenic brain abscesses is 8%–26.3%. Recently, in China, the incidence of brain abscess secondary to middle ear cholesteatoma has started to increase due to antibiotic resistance.

CASE SUMMARY

A 55-year-old male presented hearing loss in the right ear and headache for 1 mo in 2018. Computed tomography (CT) showed an area of low density in the right middle ear and mastoid and auditory ossicle defects and a small amount of soft tissue density in the left middle ear. The parietal wall of the right tympanic cavity and the posterior wall of the mastoid sinus were thin and less continuous. Cranial magnetic resonance imaging revealed an area of low intensity encapsulated by an area of high intensity in the right temporal lobe. We diagnosed him with a brain abscess secondary to middle ear cholesteatoma. He received surgery to drain the abscess followed by a modified radical mastoidectomy. The patient visited our department 3 years later because of intermittent otorrhea in the left ear. CT revealed that the area of the soft tissue density in the left middle ear and mastoid was significantly increased. The posterior wall of the mastoid sinus was destroyed, leaving the left middle ear connecting with the brain. The patient underwent a modified radical mastoidectomy in the left ear

CONCLUSION

Regular follow-up and timely treatment of contralateral ear disease are vital for the prevention of otogenic complications in patients with otogenic abscesses secondary to middle ear cholesteatoma in the unilateral ear.