A man presented with persistent ear pain and discharge, retro-orbital pain and modified radical mastoidectomy was done to him. Patient comes back with persistent discharge, what is your diagnosis?
In a patient with CSOM, persistent ear discharge with or without deep seated pain in spite of an adequate coical or modified mastoidectomy points towards petrositis. Spread of infection from middle ear and mastoid to the petrous pa of temporal bone is petrositis it can also involve adjacent 5th cranial nerve and 6" cranial nerve when it produces classical triad of symptoms - 6th nerve palsy, retro orbital pain (5th nerve) and persistent discharge from the ear, known as Gradenigo's syndrome Treatment Adequate drainage is the mainstay of treatment along with specific antibiotic therapy. Modified radical or radical mastoidectomy is often required if not done already. The fistulous tract should be identified, curetted and enlarged to provide free drainage.
Diffuse serous labyrinthitis
Purulent labyrinthitis
Petrositis
Latent mastoiditis