Cranial Nerve Palsies and Necrotizing External Otitis – Two Case Reports

Czech version

Authors: Viktor Chrobok ¹ ; Jana Dědková ²; Michal Černý ¹
Authors‘ workplace: LF UK a FN Hradec Králové Klinika otorinolaryngologie a chirurgie hlavy a krku ¹; LF UK a FN Hradec Králové Radiodiagnostická klinika ²
Published in: Cesk Slov Neurol N 2014; 77/110(1): 109-113
Category: Case Report

Overview

Necrotizing (malignant) external otitis is a life-threatening Pseudomonas aeruginosa infection of the external auditory canal leading to skull base osteomyelitis and soft tissue inflammation of the infratemporal fossa. We present two cases with facial nerve palsy and multiple cranial nerve palsies. The review of recent literature discusses the history, pathogenesis, diagnosis, and treatment of skull base osteomyelitis in the context of necrotizing otitis externa.

Key words:
external otitis – facial nerve – cranial neuropathy – osteomyelitis – Pseudomonas aeruginosa

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Sources

1. Bhandary S, Karki P, Sinha BK. Malignant otitis externa: a review. Pac Health Dialog 2002; 9(1): 64–67.

2. Handzel O, Halperin D. Necrotizing (malignant) external otitis. Am Fam Physician 2003; 68(2): 309–312.

3. Sreepada GS, Kwartler JA. Skull base osteomyelitis secondary to malignant otitis externa. Curr Opin Otolaryngol Head Neck Surg 2003; 11(5): 316–323.

4. Nadol JB, McKenna MJ. Surgery of the ear and temporal bone. 2nd ed. Philadelphia; Lippincott Williams & Wilkins 2005: 247–253.

5. Slattery WH, Brackmann DE. Skull base osteomyelitis. Malignant external otitis. Otolaryngol Clin North Am 1996; 29(5): 795–806.

6. Ali T, Meade K, Anari S, El Badawey MR, Zammit-Maempel I. Malignant otitis externa: case series. J Laryngol Otol 2010; 124(8): 846–851.

7. Rubin Grandis J, Branstetter BF jr, Yu VL. The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis 2004; 4(1): 34–39.

8. Reñé R, Mas A, Villabona CM, Ricart MC, Bassa A, Tolosa F. Otitis externa maligna and cranial neuropathy. Neurologia 1990; 5(7): 222–227.

9. Kondziella D, Skagervik I. Malignant external otitis with extensive cranial neuropathy but no facial paralysis. J Neurol 2007; 254(9): 1298–1299.

10. Rubin J, Yu VL. Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis, and therapy. Am J Med 1988; 85(3): 391–398.

11. Mehrotra P, Elbadawey MR, Zammit-Maempel I. Spectrum of radiological appearances of necrotising external otitis: a pictorial review. J Laryngol Otol 2011; 125(11): 1109–1115.