Allergic Fungal Otomastoiditis in a Patient without Allergic Fungal Rhinosinusitis: A Case Report

Patient: Female, 27 Final Diagnosis: Allergic fungal otomastoiditis – AFOM Symptoms: Left-sided otorrhea and hearing impairment for 2 years Medication: Systemic steroid course Clinical Procedure: Aural toilets and systemic steroid over 2 weeks Specialty: Otolaryngology OBJECTIVE: Rare disease BACKGROUND: Allergic fungal rhinosinusitis is an inflammatory condition involving the paranasal sinuses and linings of the nasal passages that lasts 12 weeks or longer. In 2013 Chen et al. reported the first case of middle ear allergic otomastoiditis in a patient who tested negative for allergic sinus-nasal disease. To the best of our knowledge, this is the second such case report to be published. CASE REPORT: Our patient was a 27-year-old immune-competent woman presenting with chronic left-side otorrhea and hearing loss for 2 years. An audiogram showed low- and middle-frequency, mild-to-moderate left-sided conductive hearing loss. A coronal view computed tomography (CT) image of the temporal bone showed coalescent air cells in the left mastoid with opacification of the left middle ear, but no evidence of bony erosion. Diagnosis confirmed by swab culture taken at a clinic showed Aspergillus flavus. The main treatment in such cases is usually a combination of surgical and medical therapy. CONCLUSIONS: We present the second case report of allergic fungal otomastoiditis, showing an allergic reaction to fungi in the middle ear and formation of mucin in a symptomatic patient. Otolaryngologists need to be aware of the presence of this sensitivity, both in the clinic and the operating theater.