not-yet-known not-yet-known not-yet-known unknown CASE HISTORY A 24-year-old female school teacher presented to the outpatient department (OPD) with an 8-day history of fever with chills and a 6-day history of bilateral hearing loss and tinnitus. She had been taking paracetamol for fever without any additional medications. She had a past history of myringoplasty one year prior for bilateral ear discharge, which had resolved. On examination, she was febrile with a temperature of 38.7°C, a pulse of 94 beats/min, a respiratory rate of 22 breaths/min, and blood pressure of 110/60 mm Hg. Her hearing was severely reduced bilaterally. Otoscopic examination revealed intact tympanic membranes with grade 3 retraction of the pars tensa but no discharge. Other systemic findings were normal.