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Quiz Case 1

Pamela C. Roehm, MD, PhD; John K. Niparko, MD
Arch Otolaryngol Head Neck Surg. 1999;125(10):1158-1160. doi:10.1001/archotol.125.10.1158.
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A 57-YEAR-OLD WOMAN with an extensive history of otitis media of the left ear presented with otalgia, otorrhea, decreased hearing, tinnitus, and disequilibrium. She had received multiple courses of antibiotics, which failed to alleviate her symptoms. Two biopsy specimens obtained from the external canal of her left ear at clinic visits revealed no neoplastic changes. She was hospitalized for the administration of intravenous antibiotics and serial debridement. Cultures were positive for Pseudomonas aeruginosa. The patient was discharged on a 6-week regimen of ciprofloxacin. Her otalgia decreased in intensity, but persisted despite treatment. On subsequent visits, she exhibited dehiscence of large portions of the posterior external auditory canal that warranted further surgical debridement. Coronal and transverse views of a preoperative computed tomographic scan of the temporal bone are shown in Figure 1 and Figure 2. Histologic features of biopsy samples taken at the time of debridement are shown in Figure 3.

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