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Pseudomonas Labyrinthitis Complicating Acute Otitis Media: Case Report
Ghada Kharrat1,2, Sana Ferchichi1,2, Zahra Jouini1
1ENT Department, Mohamed Taher Mâamouri University Hospital, Nabeul, Tunisia.
Abstract:
Background: Bacterial labyrinthitis has been rarely described. Pseudomonas incrimination is even exceptional. Herein, we present a case of pseudomonas labyrinthitis and discuss diagnosis, value of imaging, treatment and prognosis of this entity. Case Report: A 18-year-old female presented with left sudden hearing loss, rotatory vertigo, vomiting, and tinnitus evolving for 24 hours. Ten days earlier, she presented symptoms of acute media otitis. Otoendoscopic examination revealed a tympanic perforation with purulent otorrhea. Vestibular examination revealed a harmonious peripheric vestibular syndrome. A tonal audiogram showed a left perceptive deafness. A temporal computed tomography scan showed left opacity of the middle ear. Magnetic resonance imaging (MRI) excluded cholesteatomatous otitis, and constructive interference steady state (CISS) sequence revealed intense labyrinthine enhancement. Otorrhea sample culture isolated Pseudomonas aeruginosa. She initially received probabilistic intravenous antibiotherapy associating cefotaxime to vancomycin for 17 days, then, we switched to adapt to the antibiogram. She had a total of 25 days of antibiotic therapy and 14 days of corticosteroid treatment. She also benefited of vestibular rehabilitation and hyperbaric oxygenotherapy. The dizziness subsided, but the deafness persisted. Conclusion: Labyrinthitis is increasingly rare in the era of antibiotic therapy. P. aeruginosa is an exceptional germ in this context. MRI is an indispensable tool for the positive and the differential diagnosis.
Insights
This case report details an 18-year-old female with sudden hearing loss and vertigo caused by Pseudomonas aeruginosa labyrinthitis. While treatment resolved dizziness, hearing loss persisted, highlighting the challenges of this rare infection.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Neuroscience
Background:
- Bacterial labyrinthitis is a rare condition, with Pseudomonas involvement being exceptionally uncommon.
- This case highlights the diagnostic and therapeutic challenges associated with bacterial labyrinthitis.
Purpose of the Study:
- To present a rare case of Pseudomonas aeruginosa labyrinthitis.
- To discuss the diagnostic modalities, particularly the role of imaging.
- To review treatment strategies and prognosis for this condition.
Main Methods:
- A case report of an 18-year-old female with acute otitis media followed by labyrinthitis symptoms.
- Diagnostic tools included otoendoscopy, audiometry, temporal bone CT, and MRI with CISS sequence.
- Treatment involved intravenous antibiotics, corticosteroids, vestibular rehabilitation, and hyperbaric oxygen therapy.
Main Results:
- Pseudomonas aeruginosa was isolated from otorrhea.
- MRI with CISS sequence revealed intense labyrinthine enhancement, aiding diagnosis.
- The patient's dizziness resolved, but sensorineural hearing loss remained.
Conclusions:
- Pseudomonas aeruginosa is an exceptional pathogen in bacterial labyrinthitis.
- Magnetic resonance imaging (MRI) is crucial for diagnosing labyrinthitis and differentiating it from other conditions.
- Despite treatment, hearing loss may persist, indicating a guarded prognosis for auditory function.
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