doiSerbia

Recurrent malignant otitis externa with multiple cranial nerve involvement: A case report

Đerić Dragoslava (School of Medicine, Belgrade + Clinical Center of Serbia, Clinic for Otorhinolaryngology and Maxillofacial Surgery, Belgrade)
Folić Miljan (School of Medicine, Belgrade + Clinical Center of Serbia, Clinic for Otorhinolaryngology and Maxillofacial Surgery, Belgrade)
Janićijević Miloš (Faculty of Medical Sciences, Kosovska Mitrovica + Health Center, Department of Otorhinolaryngology, Kosovska Mitrovica)
Blažić Srbislav (School of Medicine, Belgrade + Clinical Center of Serbia, Clinic for Otorhinolaryngology and Maxillofacial Surgery, Belgrade)
Popadić Danka (Medical Center, Otorhinolaryngology Office, Vrnjačka Banja)

Introduction. Necrotizing otitis externa is a rare but conditionally fatal infection of external auditory canal with extension to deep soft tissue and bones, resulting in necrosis and osteomyelitis of the temporal bone and scull base. This condition is also known as malignant otitis due to an aggressive behavior and poor treatment response. Early diagnosis of malignant otitis is a difficult challenge. We present an illustrative case of necrotizing otitis externa and suggest some strategies to avoid diagnostic and treatment pitfalls. Case Outline. A 70-year-old patient presented with signs of malignant otitis externa, complicated by peripheral facial palsy. Adequate diagnostic and treatment procedures were performed with clinical signs of resolution. The recurrence of malignant infection had presented three months after previous infection with multiple cranial nerve neuropathies and signs of jugular vein and lateral sinus thrombosis. An aggressive antibiotic treatment and surgery were carried out, followed by substantial recovery of the patient and complete restoration of cranial nerves’ functions. Conclusion. Necrotizing otitis externa is a serious condition with uncertain prognosis. The suspicion of malignant external otitis should be raised in cases of resistance to topical treatment, especially in patient with predisposing factors. Evidence-based guideline for necrotizing otitis externa still doesn’t exist and treatment protocol should be adjusted to individual presentation of each patient.

Keywords: external ear, pseudomonas infection, facial paralysis, skull base, osteomyelitis