Malignant external otitis with facial nerve paralysis

Malignant external otitis with facial nerve paralysis:



Giancarlo Tirelli, Annalisa Gatto, Silvia Brancatelli, Alice Piccinato



Indian Journal of Otology 2019 25(4):216-218



Malignant external otitis (MOE) is a severe infection of the external auditory canal and the skull base that is often seen in elderly diabetic patients with a high mortality and morbidity rate. in >98% of cases, the causative pathogen is Pseudomonas aeruginosa. Here, we describe a case of MOE associated with facial nerve paralysis in a patient hospitalized. A 62-year-old man was referred to our department experiencing right otalgia, purulent otorrhea, ear loss, and a Grade III right facial nerve palsy according to the House–Brackmann scale. He was affected by uncompensated insulin-dependent type 2 diabetes. The patient had a history of noncholesteatomatous ipsilateral chronic otitis treated with tympanomastoid surgery 10 years before, without any sign of recurrence. After 10 days of specific antibiotic and corticosteroid therapy, symptoms were reduced and the paralysis of the superior branches of the facial nerve had improved, but the persisting swell of the ear canal did not allow a thorough evaluation of the tympanic membrane. Therefore, an explorative tympanotomy was performed, and few days after surgery, the marginalis branch paralysis of the facial nerve had improved according toelectroneurography (ENG) results, and the culture swab showed a polymicrobial flora.