Acute suppurative otitis media with facial palsy in an infant-A Rare Presentation

Acute necrotizing otitis media (ANOM), an uncommon but severe form of bacterial otitis media, a variant of acute suppurative otitis media, frequently causes distressing sequelae if not properly diagnosed and treated. A four-month-old male infant initially became ill with intermittent fever, followed by right facial nerve paralysis and right otorrhea four days later. Microscopic examination of the right ear revealed congestion and swelling of the external ear canal, perforation of the eardrum and erosions on the malleus. Culture of pus from the otic lesion grew Pseudomonas aeruginosa. The patient's condition did not improve despite systemic administration of antibiotics thus, surgical intervention was arranged. During the operation, subtotal perforation of the eardrum, edematous posterior canal wall with posterior canal wall sagging with granulations and congested polypoidal mucosa in the middle ear was seen. Antrum filled with thick organised mucopus and necrotic bone chips. Cortical mastoidectomy was conducted and pathologic examination of the surgical specimen disclosed necrotic changes in both soft and bony tissues. The patient recovered soon after surgery. His fever subsided one day after surgery and the patient was discharged in a stable condition 12 days later.