There is a minor amount of localized soft tissue swelling involving the pinna and periauricular soft tissues on the left side.  There is no significant soft tissue swelling or fluid collections involving the nasopharynx and/or the parapharyngeal, masticator, retropharyngeal and prevertebral spaces.

There is phlegmon and likely purulent material spreading within the petrous apex and to the petroclival junction on the left.

There is abnormal enhancement and/or enlargement of cranial nerve 5 cisternal segment, rootlets in the obliterated trigeminal cistern and along the lateral margin paracavernous dura in the region of V1 and along the lower margin of the paracavernous region to involve the 5th nerve ganglion on the left.

There is no definite cavernous sinus thrombosis or a cavernous carotid segment inflammation, occlusion and/or aneurysm.

The right temporal bone is normal.

The external auditory canal shows abnormal soft tissue thickening without evidence of bone erosion either of the canal or of the petrotympanic fissure.

There is an erosive process spreading along the superior aspect of the petrous apex without eroding the bony Eustachian tube and carotid canal.

There is extensive middle ear and mastoid mucosal disease/fluid present and the roof of the mastoid and middle ear are likely eroded. The sigmoid plate of the mastoid is eroded in a manner consistent with early stages of coalescent mastoiditis.

There are no dural reactive changes or a subperiosteal/epidural abscess along the sigmoid plate of the mastoid displacing the adjacent sigmoid sinus; however, there is dural reactive change and a subperiosteal and epidural abscess along superior surface of the petrous portion of the temporal bone.

The ossicles the incus body and distal long process, the incudostapedial joint and stapes are likely eroded. The facial canal is intact.

The inner ear, in particular the superior semicircular canal is normal.

There is dural reactive change along surfaces of the petrous portion of the temporal bone with a subperiosteal and epidural abscess along superior surface of the petrous portion of the temporal bone but none along tentorium or falx cerebri.

There is no likely meningitis involving the inferior temporal lobe or adjacent cerebellum or more remote meningeal sites although the involvement of the cisternal segment of cranial nerve 5 raises the possibility of meningeal involvement.

There is no brain edema and/or evolving abscess present or, specifically, involving the inferior temporal lobe or adjacent cerebellum.

There is no evidence of thrombosis, thrombophlebitis or other occlusive or inflammatory process of the sigmoid sinus, transverse sinus, the vein of Labbe’ or jugular bulb or vein.

There is no inflammation of the distal internal carotid artery.

There is no obstructive hydrocephalus - either intra or extra ventricular or signs of raised intracranial pressure.