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been treated with multiple courses of oral and local anti-
biotics, including quinolones.
Examination of the right ear revealed sagging of the
superior canal wall and a thickened tympanic membrane
with polypoid changes in the mesotympanum. There was
mucoid yellowish discharge in the canal as well.
Swab culture from the right ear showed soft tissue
attenuation of the right mastoid and right middle ear, with
suspected mild erosive changes of the anterior wall of the
external auditory canal (Fig. 1). There was mild enhance-
ment of the right side of the nasopharynx and right para-
pharyngeal space with partial involvement of the masticator
space (Fig. 2). There was dense attenuation of the right
mastoid and right middle ear, including suspected mild
erosive changes of the anterior wall of the external au-
ditory canal (Fig. 2).
Technetium and gallium scans showed intense uptake
within the right cranial base, mainly within the temporal
bone and involving the right mastoid and the petrous tem-
poral region (Figs. 3 and 4).
The patient began receiving intravenous administration
of ciprofloxacin 400 mg every 12 hours and ceftazidime
2 g every 12 hours. However, he did not respond to therapy,
and his erythrocyte sedimentation rate rose to 117 mm/h.
A right-sided myringotomy with tube placement was per-
formed. The aspirate from the middle ear grew
Aspergillus
species. The patient was then intravenously administered
amphotericin B lipid complex 400 mg once daily, but he
developed fever, chills, and severe rigors. The medication
was changed to intravenous administration of voricona-
zole 300 mg every 12 hours. One week later, the patient
was pain free, and his erythrocyte sedimentation rate (ESR)
FIG. 1.
Axial computed tomographic scan shows soft tissue
attenuation of the right mastoid and right middle ear, with suspected
mild erosive changes of the anterior wall of the external auditory canal.
FIG. 2.
Axial computed tomographic scan shows mild enhance-
ment of the right side of the nasopharynx and right parapharyngeal
space with partial involvement of the masticator space.
FIG. 3.
Technetium scan showing intense uptake within the right
cranial base, mainly within the temporal bone and involving the
right mastoid and the petrous temporal region.
FIG. 4.
Gallium scan showing intense uptake within the right
cranial base, mainly within the temporal bone and involving the
right mastoid and the petrous temporal region.
A. E. TARAZI ET AL.
Otology & Neurotology, Vol. 33, No. 5, 2012
95