title: Tularaemia of middle ear with suppurative lymphadenopathy and retropharyngeal abscess.
abstract: OBJECTIVE
  We report an extremely rare case of otitis media due to Francisella tularensis, complicated by multiple suppurative cervical lesions and a lasting conductive hearing loss.
  
  
  METHODS
  A young woman presented with otitis media, several neck swellings and a retropharyngeal swelling. Polymerase chain reaction testing of aspirated fluid and serology confirmed the diagnosis of tularaemia. Specific antibiotic therapy initiated six weeks after the onset of initial symptoms did not resolve the disease, and open surgical drainage was necessary.
  
  
  CONCLUSIONS
  Otitis media unresponsive to conventional therapy and accompanied by unusually pronounced lymphadenopathy should prompt the clinician to consider tularaemia as a differential diagnosis, in order to initiate timely, specific therapy.
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, University of Munich, Germany. robert.guerkov@med.uni-muenchen.de
authors.forename: R
authors.initials: R
authors.lastname: Gürkov
authors.forename: U
authors.initials: U
authors.lastname: Kisser
authors.forename: W
authors.initials: W
authors.lastname: Splettstösser
authors.forename: M
authors.initials: M
authors.lastname: Hogardt
authors.forename: E
authors.initials: E
authors.lastname: Krause
mesh_terms: D000328:Adult; D005260:Female; D005604:Francisella tularensis / Q000302:isolation & purification; D006314:Hearing Loss, Conductive / Q000382:microbiology; D006801:Humans; D010033:Otitis Media / Q000175:diagnosis* / Q000209:etiology; D017703:Retropharyngeal Abscess / Q000150:complications / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014406:Tularemia / Q000150:complications / Q000175:diagnosis*