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Clinical Problem Solving: Radiology
March 21, 2011

Radiology Quiz Case 2: Diagnosis

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Copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2011

Arch Otolaryngol Head Neck Surg. 2011;137(3):305. doi:10.1001/archoto.2011.27-b

The images of the left temporal bone showed ossification throughout the labyrinth. The basal turn of the cochlea was relatively spared, but there was increased density in the middle and apical turns, consistent with ossification. The edges of the vestibule appeared indistinct and hazy, and the superior semicircular canal was completely obliterated with new bone.

Suppurative labyrinthitis is a well-known complication of acute suppurative otitis media but is rare in the antibiotic era. As with other complications of acute otitis media, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis,and other Streptococcusspecies are the most commonly implicated organisms.1,2Modern labyrinthine complications are more likely to be secondary to chronic otitis media with cholesteatoma, and the causative organisms are more likely to be Pseudomonas aeruginosa, Staphylococcus aureus,and various gram-negative bacilli.1Diagnosis is suggested by severe nausea, vomiting, and vertigo associated with fever and acute suppurative otitis media. Treatment consists of intravenous antibiotics and myringotomy with tympanostomy tube placement. Aggressive treatment is warranted to prevent intracranial spread of infection, and mastoidectomy with drainage of the labyrinth has been suggested in this setting.3The acute symptoms resolve along with the infection. Vertigo is usually well compensated within 2 to 3 weeks. Some disequilibrium and positional vertigo may persist, however, and the hearing loss is profound and permanent. The hearing loss may be the result of direct damage to the neural structures of the inner ear or to progressive ossification.

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