When Ear Pain Signals More: Otomastoiditis-Related Bilateral Cranial Neuropathies in an Immunocompromised Patient

Otomastoiditis is the infection and inflammation of both the otitis media (middle ear) and the mastoid air cells. Involvement of the mastoid air cells can occur if the infection extends past the middle ear to affect contiguous structures. Fungal mastoiditis is very rare and almost exclusively seen in immunocompromised patients. We present an unusual case of a type 2 diabetic with fungal otomastoiditis manifesting as left-sided ear pain, as well as neuropathies of the left cranial nerve VII and right cranial nerve III. While facial nerve paralysis is often attributed to idiopathic causes, it is important that physicians maintain a high index of suspicion, especially when multiple cranial nerves are involved.