A Rare Presentation with Bilateral Peripheral Facial Palsy

Acute suppurative otomastoiditis (ASOM) refers to the concurrent occurrence of suppurative acute otitis media and acute mastoiditis, occurring mostly in childhood. Complications are rare in the recent era with the development of wide spectrum antibiotics. However, when the mucoperiosteal involvement evolves into osteomyelitis (OM), severe complications may develop. This generally occurs in immunocompromised patients or patients with some illnesses associated with decreased bone vascularity such as diabetes mellitus (DM). We report a 58-year-old male patient presenting with bilateral peripheral facial palsy in whom OM resulting from coalescent mastoiditis affected the skull base and the bilateral fallopian canals. In the management of ASOM, especially with the presence of the risk factors such as DM, follow up imaging is important to reveal OM of the mastoid bone before it spreads to the skull base and further it is complicated with intracranial extensions. On radiological imaging, temporal computed tomography with bone algorithm is the first method of choice to reveal early bony resorptions of OM.