Bony Destruction of Tympanic Promontory in a Case of Suppurative Otitis Media

We reported a rare case of bony destruction of the tympanic promontory in suppurative otitis media without cholesteatoma. A 62-year-old male consulted the hospital in October 2002, with complaints of impaired hearing, otorrhea, dizziness and facial palsy on the right side. Hearing in the right ear was totally gone. CT showed a defect in the cochlear bony wall with abundant soft density tissue in the middle ear cavity, antrum and mastoid cavity. Surgery was performed. The bony structure in the cochlear lower basal turn had been destroyed and membranous labyrinth was confirmed when granulation was removed. The defect was then covered with fascia and an open mastoid cavity was created. The facial nerve was also exposed. The patient showed a good postoperative course: facial nerve palsy improved to normal, dizziness and nystagmus disappeared, but deafness was irreversible.Generally, in a case of cholesteatoma, bony destruction is more frequent than in a case of suppurative otitis media and labyrinthine or facial canal dehiscence is a rather common finding. This case report showed that even in the absence of cholesteatoma, these degenerative changes could develop in suppurative otitis media and could extend to the tympanic promontory and facial canal.