Middle ear Actinomycosis: a rare cause of acute otitis media with labyrinthine fistula

Actinomycosis is a very rare pathology of the middle ear and mastoid, with less than 50 cases reported worldwide. This paper reports the case of an 11-year-old girl presenting with acute otitis media and acute vertigo owing to labyrinthine fistula. Surgical tympanomastoid exploration yields granulomatous disease of middle ear and mastoid, and histopathology shows actinomycosis. The authors report this case, which was treated by surgical debulking of the granulomatous tissue and closure of the fistula, followed by 2 weeks of intravenous treatment with penicillin and at least 3 months of oral amoxicillin. The authors discuss the challenges in managing this case in view of recent literature. Our case confirms that diagnosis of this very rare condition is only made through histopathological diagnosis after surgical exploration and requires long-term medical treatment thereafter.