Pseudomonas Labyrinthitis Complicating Acute Otitis Media: Case Report.

Abstract

Background: Bacterial labyrinthitis has been rarely described. Pseudomonas incrimination is even exceptional. Herein, we present a case of pseudomonas labyrinthitis and discuss diagnosis, value of imaging, treatment and prognosis of this entity. Case Report: A 18-year-old female presented with left sudden hearing loss, rotatory vertigo, vomiting, and tinnitus evolving for 24 hours. Ten days earlier, she presented symptoms of acute media otitis. Otoendoscopic examination revealed a tympanic perforation with purulent otorrhea. Vestibular examination revealed a harmonious peripheric vestibular syndrome. A tonal audiogram showed a left perceptive deafness. A temporal computed tomography scan showed left opacity of the middle ear. Magnetic resonance imaging (MRI) excluded cholesteatomatous otitis, and constructive interference steady state (CISS) sequence revealed intense labyrinthine enhancement. Otorrhea sample culture isolated Pseudomonas aeruginosa. She initially received probabilistic intravenous antibiotherapy associating cefotaxime to vancomycin for 17 days, then, we switched to adapt to the antibiogram. She had a total of 25 days of antibiotic therapy and 14 days of corticosteroid treatment. She also benefited of vestibular rehabilitation and hyperbaric oxygenotherapy. The dizziness subsided, but the deafness persisted. Conclusion: Labyrinthitis is increasingly rare in the era of antibiotic therapy. P. aeruginosa is an exceptional germ in this context. MRI is an indispensable tool for the positive and the differential diagnosis.