An Elderly Man with Cranial Nerve Palsies, Otalgia and Otorrhoea

THE STORY In 2001, a retired seaman in his seventies presented with a progressive history of ear pain, deafness, double vision and facial weakness. Several months prior to this he had started to notice discomfort in his right ear and parotid area, with an aural discharge. Soon afterwards he noticed a similar pain in his left ear. He consulted an ear, nose and throat (ENT) surgeon who syringed both ears and drained a right middle ear effusion by inserting a grommet and performing a myringoplasty. A nasal polyp was removed at the same time. He received a two-week course of coamoxiclav. Despite these interventions, the pain worsened and he began to have difficulty hearing in both ears. Four months later he began to experience intermittent double vision and his hearing became worse. After a short course of oral steroids he developed left facial weakness. His ENT surgeon arranged a consultation