Russ Burgin

A 68-year-old male with a history of poorly controlled diabetes presents to the ED with increasing right-sided ear and facial pain, swelling, and difficulty hearing for two weeks.  He says the pain is worse at night and when he is chewing. Today, he noticed his right face looked swollen and he had an unequal smile. Triage vital signs include BP 130/75 mm Hg, HR 90 bpm, T 37C, RR 15 breaths per minute, SpO2 98% on room air.  A point of care glucose is 148 mg/dL.  On exam, the right side of the patient’s face is notably swollen. The right ear is anteriorly displaced by surrounding edema and is erythematous with malodorous discharge.  There is facial asymmetry that involves the forehead.  Otoscopic exam reveals granulation tissue.