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1 online ML Comm Case Report Korean J Otorhinolaryngol-Head Neck Surg 2011;54: / pissn / eissn Case of Chronic Suppurative Otitis Media with Facial Nerve Palsy due to spergillus Infection Dae-Young Chung 1, Dong-Chul Kim 2, Sang Won Yeo 1 and Shi-Nae Park 1 1 Department of Otolaryngology-HNS, 2 Hospital Pathology, The Catholic University of Korea College of Medicine, Seoul, Korea 안면신경마비를동반한 spergillus 감염에의한만성화농성중이염 정대영 1 김동철 2 여상원 1 박시내 1 가톨릭대학교의과대학이비인후과학교실, 1 임상병리학교실 2 Received May 29, 2011 Revised October 4, 2011 ccepted October 12, 2011 ddress for correspondence Shi-Nae Park, MD, PhD Department of Otolaryngology-HNS, The Catholic University of Korea College of Medicine, 222 anpo-daero, Seocho-gu, Seoul , Korea Tel Fax snparkmd@catholic.ac.kr Chronic otitis media of fungal origin and its complications like facial palsy are highly unusual. lthough human exposure to spergillus is common, infections are infrequent. spergillus infections of the ear are usually limited to superficial growth on cerumen or moist debris. The main risk factor for fungal infection of middle ear is being in an immunocompromised state, which may be caused by malignant neoplasms, immunosuppressive therapy, poorly controlled diabetes mellitus, blood dyscrasia, or protein-energy malnutrition. ggressive surgical debridement is required in fungal infections with facial palsy, and the prognosis is better with early treatment. Facial palsy caused by fungal infection showed poor improvement in most of the reported cases. Early diagnosis, surgical resection and antifungal therapy with control of underlying immunologic conditions and maintenance of antifungal therapy are required for best results. Fungal otitis media with facial nerve palsy has not yet been reported in Korea. We report a case of fungal otitis media with facial palsy in an immune-compromised woman who improved with mastoid process resection and facial nerve decompression. Korean J Otorhinolaryngol-Head Neck Surg 2011;54: Key WordsZZOtitis media ㆍ Facial paralysis ㆍ spergillus. 서론 증례 866 Copyright 2011 Korean Society of Otorhinolaryngology-Head and Neck Surgery

Fungal Chronic Otitis Media with Facial Nerve Palsy Chung DY, et al. Fig. 1.

efore surgery, tympanic membrane shows necrotic central perforation and the middle ear

Three month after the surgery, grafted fascia has been well epithelialized and middle ear

xial image () & Coronal image () of temporal bone CT shows soft tissue density in the

segment, geniculate ganglion and labyrinthine segment.

2 Fungal Chronic Otitis Media with Facial Nerve Palsy Chung DY, et al. Fig. 1. Pre- and Postopeartive endoscopic pictures of the tympanic membranes. efore surgery, tympanic membrane shows necrotic central perforation and the middle ear mucosa was pale and polypoid (). Three month after the surgery, grafted fascia has been well epithelialized and middle ear space seems to be well aerated (). Fig. 2. xial image () & Coronal image () of temporal bone CT shows soft tissue density in the epitympanic space with suspicious bony erosion of fallopian canal (arrowhead) in tympanic segment & perigeniculate area. Gd-enhanced temporal bone MRI (C) shows the enhancement of facial nerve (arrow) at tympanic segment, geniculate ganglion and labyrinthine segment. Follow-up axial image of temporal bone CT, 3 month postoperatively (D) shows that right mastoidectomized cavity is filled with soft tissue again. Surgical removal of this soft tissue and histologic confirmation to rule out aspergillus infection were needed in this case. MRI: magnetic resonance image, CT: computed tomography. C D 867

Korean J Otorhinolaryngol-Head Neck Surg 2011;54:866-70 - - - - - Fig. 3.

Epitympanum was filled with pale and gray colored granulation tissue (arrows) which

fter removal of granulation tissue, eroded fallopian canal from geniculate ganglion to

Histopathologic findings of the granulation tissue in epitympanic space.

3 Korean J Otorhinolaryngol-Head Neck Surg 2011;54: Fig. 3. Surgical microscopic views of the patient. Epitympanum was filled with pale and gray colored granulation tissue (arrows) which covered the exposed facial nerve (). fter removal of granulation tissue, eroded fallopian canal from geniculate ganglion to cochleriform process (arrowheads) was clearly identified (). M: malleus. 868 Fig. 4. Histopathologic findings of the granulation tissue in epitympanic space. Prevalent fungal invasion of epitympanic tissue is visible (arrowhead, H&E stain, 200)(). Septated hyphae which is consistent with spergillus species are found within the soft tissue (arrow, methenamine silver stain, 400)().

4 Fungal Chronic Otitis Media with Facial Nerve Palsy Chung DY, et al. - 고찰

5 Korean J Otorhinolaryngol-Head Neck Surg 2011;54: acquired immunodeficiency syndrome. m J Otol 1999;20(5): ) van Tol, van Rijswijk J. spergillus mastoiditis, presenting with unexplained progressive otalgia, in an immunocompetent (older) patient. Eur rch Otorhinolaryngol 2009;266(10): ) ryce GE, Phillips P, Lepawsky M, Gribble MJ. Invasive spergillus tympanomastoiditis in an immunocompetent patient. J Otolaryngol 1997;26(4): ) Yun MW, Lui CC, Chen WJ. Facial paralysis secondary to tympanic mucormycosis : case report. mj Otol 1994;15(3): ) Stanley RJ, McCaffrey TV, Weiland LH. Fungal mastoiditis in the immunocompromised host. rch Otolaryngol Head Neck Surg 1988; 114(2): ) Kim JH, Song CE, Jun C, Lee DH. case of fungal ball of spergillus in chronic otitis media. Korean J Otolaryngol-Head Neck Surg 2006;49(6): ) Connolly JL, Carron JD. Invasive spergillus of the temporal bone. m J Otolaryngol 2007;28(2): ) Haruna S, Haruna Y, Schachern P, Morizono T, Paparella MM. Histopathology update: otomycosis. m J Otolaryngol 1994;15(1): ) Ohki M, Ito K, Ishimoto S. Fungal mastoiditis in an immunocompetent adult. Eur rch Otorhinolaryngol 2001;258(3): ) Strauss M, Fine E. spergillus otomastoiditis in acquired immunodeficiency syndrome. m J Otol 1991;12(1): ) Kim Y, Kang MK, Hwang CH, Lee H. Skull base osteomyelitis caused by invasive Candida infection. Korean J Otolaryngol-Head Neck Surg 2006;49(7): REFERENCES 1) Chen D, Lalwani K, House JW, Choo D. spergillus mastoiditis in 870

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A 617 Special Issue Diabetic Retinopathy Won Ki Lee, M.D. Department of Ophthalmology The Catholic University of Korea College of Medicine Kangnam St. Mary s Hospital E mail : wklee@catholic.ac.kr Abstract R