Question: A 34 year old female is evaluated for recurrent meningitis by a neurology colleague. The patient has no major medical comorbidities and is not immunocompromised. Your colleague noted that the patient described having to use her left ear to hear as her right ear “never worked since birth”. Exam of both ears in the clinic is unremarkable and the patient has never had ear surgery. Which potential pathophysiologic mechanism could be responsible for her infections?

a) Enlarged vestibular aqueduct leading to spread of middle ear infection to the dura

b) Malformation of the inner ear

c) Chronic suppurative otitis media with intracranial spread

d) Otosclerosis resulting in loss of bone density around the otic capsule and spread of middle ear infection

[Answer will be posted with next week's new question]

Answer to last week's question, “Sequence Of Events” (June 22, 2020)

D - Septal hematoma with resultant loss of caudal septum.