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Malignant Otitis Externa and Stroke
Marta Catarino Manso1, Simão C Rodeia1, Sofia Rodrigues1
1Department of Internal Medicine, Hospital de Egas Moniz, Lisboa, Portugal.
Abstract:
Malignant otitis externa (MOE) is an aggressive but benign entity which evolves into skull base osteomyelitis. An 81-year-old female patient was admitted for left hemiparesis and homonymous hemianopia. She complained of headache radiating to the right cervical area. A recent history of recurrent otitis media was present. Head and neck imaging showed an ischemic infarction (right temporo-occipital) and a parapharyngeal soft tissue mass originating in an external and medial ear infection. Culture samples revealed Pseudomonas aeruginosa infection leading to the diagnosis of Malignant otitis externa (MOE). Parenteral antibacterial therapy and hyperbaric oxygen therapy resulted in improvement.
Learning Points:
Malignant otitis externa is an aggressive and life-threatening disease which must be identified early and treated promptly for therapeutic success.Although starting as an outer ear infection (typically caused by Pseudomonas aeruginosa) local spread can involve noble head and neck structures leading to variable signs and symptoms.Modern imaging techniques can help define structure involvement (MRI) and may help identify disease activity and prognosis (nuclear medicine).
Insights
Malignant otitis externa (MOE), an aggressive skull base osteomyelitis, requires early diagnosis and prompt treatment. This case highlights Pseudomonas aeruginosa infection leading to severe neurological symptoms, successfully managed with antibiotics and hyperbaric oxygen therapy.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Neurology
Background:
- Malignant otitis externa (MOE) is an aggressive infection that can progress to skull base osteomyelitis.
- Early recognition and prompt treatment are crucial for successful outcomes in MOE.
- MOE can present with diverse neurological symptoms due to local spread.
Purpose of the Study:
- To report a case of malignant otitis externa presenting with neurological deficits.
- To emphasize the importance of early diagnosis and multimodal treatment for MOE.
- To illustrate the diagnostic utility of advanced imaging in MOE.
Main Methods:
- Case presentation of an 81-year-old female with hemiparesis and hemianopia.
- Diagnostic workup included head and neck imaging (MRI) and microbiological cultures.
- Treatment involved parenteral antibacterial therapy and hyperbaric oxygen therapy.
Main Results:
- Imaging revealed ischemic infarction and a parapharyngeal soft tissue mass secondary to ear infection.
- Cultures identified Pseudomonas aeruginosa as the causative agent of MOE.
- The patient showed clinical improvement following treatment.
Conclusions:
- Malignant otitis externa is a life-threatening condition necessitating early identification and intervention.
- Pseudomonas aeruginosa is a common pathogen in MOE, capable of causing extensive local spread.
- Advanced imaging modalities like MRI and nuclear medicine are valuable for assessing disease extent and prognosis.
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