Postauricular Cutaneous Mastoid Fistula: Case Report

Introduction: Chronic suppurative otitis media (CSOM) is a common condition of the middle ear that can develop serious complications without optimal treatment. Postauricular fistula mastoid is a rare complication, only few cases are reported in the literature.

Objective: The study aims to report a rare complication of a CSOM.

Resumed report: A 79-year-old male presented with 3 weeks of pain in the left ear and retroauricular purulent discharge. He also complained of binaural hearing loss and intermittent otorrhea in the left ear. The patient had previous history of three otologic surgeries, the last one a conservative tympanomastoidectomy 42 years ago. Otoscopy revealed attic retraction pocket and epidermal debris with fetid and festering secretion. No ossicles were seen. Left mastoid fistula about 0.5-cm diameter was visualized with purulent discharge and local inflammatory signs. Audiometry showed severe mixed hearing loss at the right ear and cofosis at the left ear. Computed tomography showed soft-tissue density in the middle ear and tympanic tegmen erosion, reassuring the suspicion of a cholesteatoma. Treatment with ceftazidime resulted in closure of the postauricular fistula. Posteriorly, radical mastoidectomy was performed on the left ear.

Conclusion: CSOM complications, such as postauricular fistula mastoid, still are a challenge as the disease often presents in the advanced stage leading to difficulty in management.