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Nicola Su1, Irfan Syed, Richard Garth

  • 1ENT Department, Derriford Hospital, Plymouth, UK. nsu@doctors.org.uk

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Malignant otitis externa is a rare, fatal necrotizing infection. This case highlights skull base osteomyelitis in an immunocompetent patient following mastoid surgery, presenting with unusual symptoms.

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Area of Science:

  • Otolaryngology
  • Infectious Diseases
  • Neurosurgery

Background:

  • Malignant otitis externa (MOE) is a severe necrotizing infection of the external auditory canal.
  • It can lead to osteomyelitis of the skull base, particularly in elderly, diabetic, or immunocompromised individuals.
  • Classic symptoms include severe otalgia, progressing to cranial nerve deficits.

Observation:

  • A 72-year-old immunocompetent, non-diabetic male presented with facial weakness, dysphagia, and weight loss.
  • Initial diagnosis considered cerebrovascular event.
  • The patient had undergone mastoid surgery prior to symptom onset.

Findings:

  • The patient was diagnosed with skull base osteomyelitis.
  • The osteomyelitis was secondary to malignant otitis externa.
  • This occurred as a complication of mastoid surgery.

Implications:

  • This case underscores that MOE can occur in immunocompetent patients.
  • It highlights atypical presentations of MOE and its complications.
  • Early recognition and management are crucial to prevent severe outcomes like skull base osteomyelitis, even post-surgery.