A 58-year-old man visited our hospital with complaints of temporal headache, hoarseness, dysphagia and left hearing loss. Palsy was noted in the left soft palate, vocal cord and sternomastoid muscle. And also hyperesthesia was noted in the first branch of the left trigeminal nerve and hypoesthesia in the other branches of the nerve. His left hearing was reduced to total deafness. Enhanced CT scan and MRI showed signs of acute mastoiditis with internal jugular vein thrombosis and inflammation around the sigmoid sinus (sinus phlebitis). The mastoiditis had resulted from infection of MRSA; methicillin resistant Staphylococcus aureus. Mastoidectomy was performed, as the antibiotic therapy with Vancomycin did not work for the mastoiditis. At the time of the operation, inflammatory mucous membrane in the mastoid cavity and the bone defect on the lateral semicircular canal were observed, but neither granulation nor abscess was observed. Two days after the operation, redness around the ear was noted, so the wound was opened. Thereafter, curettage of the granulation with irrigation in the mastoid cavity was repeated. The palsy of the left soft palate improved, and the inflammation decreased. When the MRSA turned to Pseudomonas aeruginosa, the antibiotic drug was changed to Imipenem. However, the temporal headache was not relieved and the inflammation increased again. Therefore, further mastoidectomy with tympanoplasty was performed. At the time of the second operation, a fracture on the middle base of the skull and a fistula on the lateral semicircular canal were observed. Postoperatively, the temporal headache and the inflammation improved. A month after the operation, the palsy of the left soft palate, sensation in the face and the sternomastoid muscle functions recovered. Eleven months after the operation, movement of the vocal cord has been improving gradually.
