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VOLUME 14 , ISSUE 1 ( January-April, 2022 ) > List of Articles

CASE REPORT

A Rare Case of Middle Ear Mucormycosis Presenting with Facial Nerve Palsy

Bharathi Murundi Basavaraj, Rakesh Bambore Suryanarayan Rao, Thanzeem Unisa, Sriram Madhan, Kavya Sivapuram

Keywords : Amphotericin B, Facial palsy, Middle ear, Mucormycosis

Citation Information : Basavaraj BM, Rao RB, Unisa T, Madhan S, Sivapuram K. A Rare Case of Middle Ear Mucormycosis Presenting with Facial Nerve Palsy. Int J Otorhinolaryngol Clin 2022; 14 (1):33-35.

DOI: 10.5005/jp-journals-10003-1416

License: CC BY-NC 4.0

Published Online: 22-04-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Introduction: Mucormycosis is an uncommon emerging fungal infection with high morbidity and mortality among diabetic and immunocompromised patients. The most common clinical manifestation is rhino-orbito-cerebral mucormycosis. Occurrence of middle ear mucormycosis with facial palsy is very rare. Case description: We report a case of a 59-year-old male patient who was presented with ear pain, ear discharge, and facial asymmetry. On clinical examination House-Brackman grade IV facial nerve palsy was noted and otoendoscopy showed external auditory canal edema, subtotal tympanic membrane perforation, necrotic malleus, lenticular process erosion with pale granulation tissue in anterior epitympanum. High resolution computed tomography (HRCT) temporal bone revealed soft tissue density in middle ear, mastoid, and external auditory canal with mild erosion of tegmen tympani and rarefaction of facial canal at first genu and tympanic segment with thickening and edema of first genu of facial nerve. Based on histopathological diagnosis of mucormycosis, patient was started on liposomal amphotericin B injection and clinical improvement was noted after a total dose of 3500 mg over 16 days. Conclusion: Early diagnosis and treatment with antifungals, glycemic control, and other supportive treatment with regular facial physiotherapy remain the mainstay of management in mucormycosis. Amid an increased number of COVID-19-associated rhino-orbito-cerebral mucormycosis, we report an unusual case of facial nerve palsy secondary to middle ear mucormycosis emphasizing the need for surgeons to have a broad mind to look for fungal infection in patients presenting with above-mentioned complaints and refractory to antibiotics.


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