Authors

C Y Y Wong, R Gan, S Ghosh, L Condon

Abstract Title

A case of infratemporal fossa Aspergilloma presenting as otitis externa

Background

We report a case presenting as otitis externa which bacterial and fungal swabs and cultures failed to provide a diagnosis. Further imaging revealed extensive chronic inflammatory lesion in the infratemporal fossa, with no destruction of auditory canal.

Objectives

To highlight the difficulties faced in making a precise diagnosis in an extensive infratemporal fossa Aspergilloma presenting as non-resolving otitis externa.

Methods

Retrospective case review

Results

1. Patient was non-responsive to empirical antimicrobial treatment for malignant otitis externa.

2. Antifungal treatment (Liposomal Amphotericin B followed by Voriconazole) led to significant clinical improvement, reflecting on subsequent repeat imaging with reversal of bone destruction.

3. Aspergillus found in a mastoid bone marrow trabeculae following histological staining, five months following first biopsy.

Conclusions

Non-resolving otitis externa should prompt further search in regions such as the infratemporal fossa and skull base and a wider search for causative pathogens. Difficulty in establishing fungal aetiology should support early initiation of antifungal treatment.