OBJECTIVE: To demonstrate how rapid interventions in middle ear infections may prevent serious complications. An 18-year-old girl with a history of malodorous otorrhea since childhood presented with headache, earache, and vomiting episodes for the past 2 months without nausea that ceased spontaneously. Physical examination revealed fever (Tax 39°C), pallor, important otalgia, and purulent otorrhea. Prior computed tomography (CT) images revealed destruction and opacification of the mastoid cells, tympanic cavity veiling, and epitympanum with extensive ossicular and bone wall destruction. A solution of continuity was observed between the tegmen tympani and the dural. CT revealed pneumocephalus near the sinodural angle, and greater bone destruction in the middle ear and mastoid in relation to the first examination. The patient was started on broad-spectrum antibiotics, and examination of the cerebrospinal fluid excluded the possibility of meningitis with subsequent radical right side mastoidectomy. We observed large exhibition of meninges and facial nerve dehiscence in the horizontal portion and lateral semicircular canal fistula and an abscess near the sinodural angle, which was drained. The patient recovered well postoperatively. A culture of the middle ear effusion revealed Enterococci faecalis. CONCLUSION: It is a challenge to prevent the progression of ear infections to chronic otitis. Treating chronic media otitis correctly is critical. In cases of complications, surgical treatment may change the prognosis of the patient.