Floating labyrinth: A unique finding on CT scan

We report a case of a 67-year-old female patient that presented to the emergency department with complete right facial paralysis, progressive hearing loss and chronic otorrhea. A unique finding on CT scan is reported: a “floating labyrinth” – cochlea, vestibule and semicircular canals extensively surrounded by soft tissue density material but with intact thinned otic capsule walls. A transotic approach was performed for removal of noncholesteatomatous inflammatory tissue; intravenous antibiotics and corticosteroids led to partial recovery of facial nerve function. A chronic suppurative otitis media with necrotic osteomyelitis and bony sequestrum in a severe context of AIDS is the likely cause. An immunosuppressive disease should be suspected in atypical presentations of chronic suppurative otitis media without cholesteatoma.