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Dysphagia due to necrotizing otitis externa.

Rajesh Dwivedi1, Melroy Rasquinha1, Rowan Harwood2

  • 1Nottingham University Hospitals, Nottingham, UK.

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|May 5, 2021
PubMed
Summary

Necrotizing otitis externa (NOE) can cause serious complications like skull-based osteomyelitis and cranial nerve palsies. Early suspicion is crucial, even without typical ear pain, for prompt diagnosis and treatment.

Keywords:
deliriumdysphagialower motor neuron palsynecrotizing otitis externaolder peopleskull-based osteomyelitis

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Area of Science:

  • Otolaryngology
  • Infectious Diseases
  • Neurology

Background:

  • Necrotizing otitis externa (NOE) is a severe infection typically seen in elderly, diabetic patients.
  • Prompt diagnosis and treatment are essential to prevent severe complications.

Observation:

  • An 88-year-old man presented with delirium, hoarseness, and oropharyngeal dysphagia.
  • Symptoms were attributed to skull-based osteomyelitis secondary to NOE, leading to lower cranial nerve palsies (X, XII) and venous sinus thrombosis.
  • Diagnosis was delayed due to the absence of otalgia, a normal-appearing external auditory canal, and the patient not being diabetic.

Findings:

  • The patient's condition deteriorated, and he died despite receiving intravenous antibiotics.
  • This case highlights the potential for NOE to present atypically and lead to life-threatening complications.

Implications:

  • A high index of suspicion for NOE and its complications is necessary in patients with otolaryngeal symptoms, even with atypical presentations.
  • Early recognition and aggressive management are critical for improving patient outcomes in cases of NOE.