Post-operative Ear Drainage and Complications in Pregnant Patient Following Mastoidectomy
Case at a Glance
A 28-year-old pregnant woman presents with persistent purulent ear discharge, pain, and neurological symptoms three months following major otological surgery, raising concerns for post-operative infection during pregnancy.
Patient's Story
The patient is a 28-year-old woman who is currently 13 weeks pregnant. She has a medical history significant for bilateral moderate-severe sensorineural hearing loss requiring hearing aids. Three months prior, she underwent major otological surgery (mastoidectomy with tissue grafting) for what appears to have been chronic ear disease. Post-operatively, she had BIPP (Bismuth Iodoform Paraffin Paste) gauze packing removed approximately one month after surgery, which was described as traumatic with significant bleeding. Since then, she has experienced ongoing symptoms including constant yellow-white purulent discharge from the operated ear, a sensation of fullness especially when lying on the affected side, ear fatigue with burning pain when pressure is applied, persistent numbness of the right side of tongue and areas around the surgical site, and general malaise.
Initial Assessment
Physical examination reveals active purulent discharge from the right ear canal with yellow-white exudate. The patient reports tenderness and burning sensations around the surgical site. Neurological examination shows persistent numbness affecting the right side of the tongue and areas surrounding the surgical scar, suggesting possible nerve involvement. The patient appears generally unwell but it is unclear whether this is related to pregnancy or the ear condition.
The Diagnostic Journey
The patient has been waiting for follow-up ENT appointments and hearing assessments through the public healthcare system. Given the persistent discharge, pain, and neurological symptoms three months post-operatively, there is concern for post-surgical infection, possible graft failure, or other complications. The pregnancy adds complexity to both diagnostic imaging options and treatment considerations.
Final Diagnosis
Suspected post-operative otitis media/mastoiditis with possible surgical site infection, complicated by pregnancy. Differential diagnosis includes graft failure, chronic otitis media, or other post-surgical complications.
Treatment Plan
Urgent ENT consultation required for evaluation of persistent discharge and possible infection. Microbiological culture of ear discharge to identify causative organisms and guide antibiotic therapy. Pregnancy-safe antibiotic therapy if infection is confirmed. Audiological assessment to evaluate hearing status post-surgery. Close monitoring given pregnancy status and potential need for revision surgery if conservative management fails.
Outcome and Follow-up
Patient requires immediate medical attention given the combination of persistent purulent discharge, neurological symptoms, and pregnancy. Long-term follow-up will depend on culture results and response to treatment. Multidisciplinary care involving ENT, obstetrics, and possibly infectious disease specialists may be necessary.