Clinical Case Database / Category: Case Based Discussion

Management of an otological emergency

Publication details

G L Noblet, N L Whitham & S C Day, A K Arya, E Osman, A C Swift
Foundation Years Journal, volume 4, issue 7, p.24 (123Doc Education, London, July 2010)


A 25-year-old man with a long history of otitis media with effusion presented with a right-sided facial nerve palsy and ipsilateral facial swelling. Examination revealed complete facial nerve palsy and erythema and swelling over the right side of his face. Otoscopy showed a tympanic perforation and an attic polyp. A working diagnosis of cholesteatoma was made and confirmed by CT. He was treated with intravenous and topical antibiotics and systemic steroids. The cholesteatoma was removed by urgent modified radical mastoidectomy and the facial nerve was decompressed. The presentation, investigation and management of this patient highlight serious complications arising from cholesteatoma and the importance and potential success of swift diagnosis and treatment. Points for consideration raised by this case include facial nerve paralysis, acute and chronic otitis media and cholesteatoma.

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G L Noblet, N L Whitham & S C Day

Foundation Year 1 Doctor
Aintree University
Hospital NHS Foundation Trust, Liverpool, L9 7AL

A K Arya

Specialist Registrar, Mersey Deanery

E Osman

Consultant in Otolaryngology, Head & Neck Surgery
and Honorary Senior Lecturer
Department of Otolaryngology, Head and Neck Surgery
Aintree University Hospital NHS Foundation Trust, Liverpool, L9 7AL

A C Swift

Consultant in Otolaryngology
Head & Neck Surgery and Honorary Senior Lecturer
Department of Otolaryngology, Head and Neck Surgery
Aintree University Hospital NHS Foundation Trust, Liverpool, L9 7AL


1. House, J.W. and Brackmann, D.E. (1985) Facial nerve grading system. Otolaryngol. Head Neck Surg. 93:146–147.


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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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