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Background <p>Otogenic infections can rapidly lead to life-threatening complications due to proximity to neurovascular structures. Foreign bodies, such as cockroaches, may worsen inflammation and trigger severe local and systemic effects.</p> Case Presentation <p>A 70-year-old male developed acute mastoiditis following cockroach entrapment in the left ear. Initial symptoms included otalgia and House-Brackmann grade 2 facial nerve (CN VII) palsy. Despite antibiotics and steroids, the condition progressed to involve CN IX, X, and XII, internal jugular vein thrombosis, intracranial hemorrhage, and septic shock. Imaging showed EAC opacification, mastoiditis, vascular thrombosis, and intracranial involvement. Despite intensive care and broad-spectrum antibiotics, the patient died from septic shock and multiorgan failure.</p> Discussion/Conclusion <p>This case highlights the aggressive potential of foreign body-induced otogenic infections, with rapid neurovascular and CNS involvement. Sequential cranial nerve palsies indicate progression. Early imaging, microbiological evaluation, and aggressive sepsis and surgical management are essential to improve outcomes and prevent fatal complications.</p>

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When A Foreign Body Turns Fatal: Rapid Progression of Acute Mastoiditis with Facial Nerve Palsy

  • 期刊论文

  • 发表日期：

    2025年6月24日

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  • Alex Zxi Jian Ho,
  • Andrew Kie Kion Tan,
  • Murukesavan Shaila,
  • Iylia Ajmal Othman,
  • Hui Mon Teh

摘要

Background

Otogenic infections can rapidly lead to life-threatening complications due to proximity to neurovascular structures. Foreign bodies, such as cockroaches, may worsen inflammation and trigger severe local and systemic effects.

Case Presentation

A 70-year-old male developed acute mastoiditis following cockroach entrapment in the left ear. Initial symptoms included otalgia and House-Brackmann grade 2 facial nerve (CN VII) palsy. Despite antibiotics and steroids, the condition progressed to involve CN IX, X, and XII, internal jugular vein thrombosis, intracranial hemorrhage, and septic shock. Imaging showed EAC opacification, mastoiditis, vascular thrombosis, and intracranial involvement. Despite intensive care and broad-spectrum antibiotics, the patient died from septic shock and multiorgan failure.

Discussion/Conclusion

This case highlights the aggressive potential of foreign body-induced otogenic infections, with rapid neurovascular and CNS involvement. Sequential cranial nerve palsies indicate progression. Early imaging, microbiological evaluation, and aggressive sepsis and surgical management are essential to improve outcomes and prevent fatal complications.