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[Malignant external otitis caused by Pseudomonas aeruginosa. Report of 3 cases]
Abstract:
The cases of three patients aged over sixty, diabetic for a long time and having clinical, otological, neurological and microbiological findings of malignant external otitis by Pseudomonas aeruginosa are registered. The first patient, a 62 years old woman, had important neurological alterations, such as proven P. aeruginosa meningitis and involvement of the 6th, 7th, 8th, 9th and 10th left cranial nerves. Although mortality and morbidity rates of cases with these characteristics are reported to be high, this patient survived. The second was a 64 years old male with the classical complaints of this condition consisting of persistent and intensive ear pain, serous purulent discharge and an emerging tumourous lesion in the left external ear canal. Good results were obtained with the surgical treatment administered along with an antimicrobial plan which remained incomplete because the patient has requested his discharge from the hospital. In less than one month, he was again hospitalized already presenting neurological manifestations (paralysis of the 6th cranial nerve) following a fatal course in a few days. The third was also a male patient, 70 years old, whose initial complaints occurred after a month a butterfly penetrated his right ear during his sleep. In spite of the presence of neurological troubles (facial paralysis and stupor) he survived with a prolonged antibiotic therapy. After a literature revision on this pathology, considerations are made concerning its pathogeny, clinical findings, diagnosis, therapy and prognosis.
Insights
Malignant external otitis caused by Pseudomonas aeruginosa can present with severe neurological complications, particularly in elderly diabetics. Despite high-risk factors, prompt treatment can lead to survival in some complex cases.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Neurology
Background:
- Malignant external otitis (MEO) is a severe infection of the external auditory canal, often caused by Pseudomonas aeruginosa.
- Elderly patients with diabetes mellitus are at increased risk for MEO and its complications.
Observation:
- Three cases of MEO in elderly diabetic patients are presented, highlighting diverse clinical presentations and neurological involvement.
- Case 1: A 62-year-old woman with P. aeruginosa meningitis and multiple cranial nerve palsies survived despite a grave prognosis.
- Case 2: A 64-year-old male with otalgia, discharge, and aural mass experienced fatal neurological progression after incomplete treatment.
- Case 3: A 70-year-old male with facial paralysis and stupor, following an insect bite, survived with prolonged antibiotic therapy.
Findings:
- Pseudomonas aeruginosa is the primary pathogen in MEO, leading to significant morbidity and mortality.
- Neurological complications, including meningitis and cranial nerve palsies, indicate advanced disease and poorer outcomes.
- Successful management requires a multimodal approach, including surgical intervention, appropriate antimicrobial therapy, and supportive care.
Implications:
- This case series underscores the critical importance of early diagnosis and aggressive management of MEO in high-risk populations.
- Neurological involvement necessitates intensive treatment and close monitoring due to its association with severe outcomes.
- Further research into optimal therapeutic strategies for complex MEO cases is warranted to improve patient survival and quality of life.