An
audiogram showed mixed hearing loss in the left
ear: the hearing loss was purely conductive below
4000 Hz and mostly sensorineural above that
frequency. The right ear had purely sensorineural
hearing loss above 4000 Hz, paralleling the leftsided
loss (Fig. 1 in the Supplementary Appendix,
available with the full text of this article at
NEJM.org). Azithromycin, methylprednisolone in
a tapering dose, and an otic solution of neomycin,
polymyxin B, and hydrocortisone were prescribed,
but the patient discontinued the glucocorticoid
because of insomnia.
The pain resolved,
but blockage persisted; on follow-up by an otolaryngologist
3 days later, myringotomy with tube
placement was performed and ciprofloxacin and
dexamethasone drops were prescribed. The patient
was advised to keep water out of the ear.
On follow-up 3 weeks later , the patient reported improved hearing
and no pain. On examination, abundant debris
was found and removed from the left ear canal;
dried serous material covered the left tympanic
membrane, and granulation tissue obstructed the
lumen of the tube. The speech-reception threshold
was in the 35-dB range; other findings were unchanged.
The tube was removed and the middle
ear was aspirated, without evidence of purulence.
3週間後の経過観察で、患者は聴力の向上と痛みがない事を報告した。検査では、剥離した壊死組織片が見つかり、左耳の外耳道から取り除かれた；液体が乾いたような成分が左鼓膜を覆い、肉芽組織がチューブの管腔をふさいでいた。語音聴取域値検査は、35-dB領域であった；そのたの所見は変化なしであった。
チューブは取り除かれ、中耳は膿を吸引され、膿の兆候はない。
3週間後の経過観察で、患者は聴覚の改善と痛みがないことを報告した。検査において、多くの残屑が見られ、左の外耳道から取り除かれた。乾いた漿液状の物質は左鼓膜を塞ぎ、また肉芽組織は管腔チューブ挿入の障害となった。
語音聴取閾値は35dBのレベルであり、他の検査結果は変化なしであった。
チューブは切除され、中耳は化膿の症状もなく吸引された。
Acetic acid drops were prescribed. Results
of laboratory tests, performed later that week at
the other hospital, are shown in Table 1.
Two weeks later, the patient fell while jetskiing
on a river, exposing her left ear to the
water. Pain in the ear recurred, and she returned
to the emergency department at MEEI 5 days later.
She rated the pain at 3 to 4 on a scale of 1 to 5,
with 5 indicating the most severe pain. The left
auricle was tender on manipulation, without tragal
pain. There was wet, white debris in the ear
canal, with no perforation, effusion, or drainage.
Other findings were unchanged. A 10-day course
of amoxicillin–clavulanic acid was begun.
.
2週間後、患者は川でジェットスキー中に転落し、左耳が水に触れている。耳の痛みが再発し、5日後、彼女はMEEIの緊急病棟へ戻った。彼女一番痛みが激しいのを5とした場合の5段階評価にて、彼女の痛みは3～4であると見積もった。左耳介は触診では柔らかく、耳珠の痛みはない。湿っており、外耳道に白い壊死組織片があるが、孔、耳だれ、排膿はない。
その他の所見は変化無しであった。10日コースのアモキシシリン・クラブラン酸がはじめられた。
On follow-up examination 1 week later, 3.5
months after the onset of symptoms, the pain
had resolved. The tympanic membrane was retracted, with an effusion but without perforation.
A ballottable (mobile when palpated) subcutaneous
mass, thought to be a cyst, emerged
from the posterior superior quadrant of the external
auditory canal and obscured the pars flaccida.
Other findings were unchanged. Computed
tomography (CT) of the temporal bone 1 week
later revealed a hyperdense soft-tissue mass,
3.2 cm by 2.5 cm by 4 cm, against the lateral
aspect of the left mastoid bone and mastoid
process, medial to the auricle.
