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Malignant external otitis with multiple cranial nerve involvement.

J M Damiani, K K Damiani, S E Kinney

    The American Journal of Otology
    |October 1, 1979
    PubMed
    Summary
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    Malignant external otitis can cause extensive skull base infections and multiple cranial nerve deficits, especially in elderly diabetics. Early antibiotic treatment and surgery can improve outcomes, though mortality remains high.

    Area of Science:

    • Otolaryngology
    • Infectious Diseases
    • Neurology

    Background:

    • Malignant external otitis (MEO) is a severe infection of the external auditory canal.
    • It primarily affects elderly, diabetic patients and can lead to significant morbidity.

    Observation:

    • Presents a case of bilateral MEO with multiple cranial nerve deficits.
    • Reviews 35 similar cases from world literature, noting involvement of all cranial nerves except the first and fourth.

    Findings:

    • Pseudomonas osteomyelitis is the underlying pathology, potentially spreading to the skull base and other structures.
    • The preferred treatment involves long-term systemic antibiotics followed by surgical intervention if disease progresses.
    • The overall mortality rate in this series is 61% (22/36), which is lower than previously reported figures.

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    Implications:

    • Highlights the aggressive nature of MEO in immunocompromised patients.
    • Emphasizes the importance of prompt and aggressive management, including antibiotics and surgery.
    • Suggests potential for improved outcomes with current treatment strategies despite high mortality.