Simultaneous Laryngeal and Mastoid Coccidioidomycosis: A Case Report and Literature Review

A 72-year-old Caucasian woman from the Southwestern United States presented with chronic right ear pain, hearing loss, and progressive hoarseness. Prior treatments, including balloon sinuplasty and tympanostomy tube placement, failed to resolve her symptoms. Imaging revealed right mastoid opacification, while flexible laryngoscopy demonstrated erythematous and polypoid changes of the right larynx. Pathology from biopsies of both the middle ear and larynx revealed spherules consistent with Coccidioides infection. She was treated with systemic fluconazole and underwent tympanomastoidectomy with mastoid debridement. The patient's postoperative course was uneventful, and she reported symptomatic improvement at follow-up. A multidisciplinary approach, including close coordination with infectious disease, guided long-term antifungal therapy. Coccidioidomycosis is a rare but important consideration in patients presenting with chronic head and neck symptoms, especially in endemic regions. This case highlights the potential for multifocal otolaryngologic involvement and underscores the need for a high index of suspicion in persistent or unexplained laryngeal and otologic disease. Diagnosis relies on biopsy and culture, and management typically requires both surgical and prolonged antifungal therapy. Multidisciplinary care is essential to optimize outcomes, particularly in cases involving bony structures or immunocompromised hosts.