An Unusual Presentation of Nectrotizing Otitis Externa in an Elderly Patient

Necrotizing otitis externa (NOE) is a rare but life-threatening condition that can often be challenging to diagnose. In this case report, we describe a rare presentation of NOE in an 83-year-old man with subtle signs of multiple unilateral cranial nerve palsy (VII, VIII, IX, X, XII). Prior to this, he had a three-month history of bilateral otitis externa, managed with topical and oral antibiotics. NOE was confirmed on CT head, which revealed left-sided skull base osteomyelitis (SBO). A repeat CT scan revealed left sigmoid sinus thrombosis and intracerebral abscess, indicative of disease progression. He was treated with ototopic and long-term systemic antipseudomonal antibiotics but unfortunately he was too frail, with a Clinical Frailty score (CFS) of 7, for further surgical management. The disease progressed despite ward-based treatment and he sadly passed away.