[Otitis externa maligna and cranial neuropathy]

Important note: Information in this article was accurate in 1991. The state of the art may have changed since the publication date.

[Otitis externa maligna and cranial neuropathy]

Neurologia. 1990 Aug-Sep;5(7):222-7. Unique Identifier : AIDSLINE MED/91144854
Rene R; Mas A; Villabona CM; Ricart MC; Bassa A; Tolosa F; Seccion de Neurologia, Otorrinolaringologia, Hospital de Son; Dureta, Palma de Mallorca.

Abstract: Malignant external otitis (MEO) is a disease of the external auditive channel (EAC) due to Pseudomonas aeruginosa which usually involves individuals with diabetes mellitus. It may result in the invasion of the cranial base with cranial neuropathy and a high mortality rate despite therapy. We report the clinical features, diagnostic procedures, evolution and therapy of 8 patients with MEO, seven of which had cranial neuropathy. All patients have diabetes except one who had acquired immunodeficiency syndrome. All had otalgia, otorrhea and headache lasting for several months. Six patients had homolateral (as related to the MEO) facial palsy. One patient with bilateral MEO developed bilateral facial palsy and lesion of the cranial nerves VI (unilaterally) and IX through XII (bilaterally). In all patients P. aeruginosa was cultured from the EAC exudate scintigraphy with 99Tc showed uptake at medium ear and mastoid level in all 8 patients, suggesting a possible osteomyelitis. Scintigraphy with 67Ga was positive in the 6 cases where it was carried out, showing uptake in the soft tissues of the cranial base. Computed tomography was carried out in 6 patients, and it was useful to define the anatomical extent of the disease. The patients received different therapeutic schedules, particularly the combination of a betalactamic and aminoglucoside antibiotics. Follow up was characterized by common recurrences, and one patient died. The importance of early diagnosis and treatment to prevent the extension and recurrence of MEO are discussed. Cranial neuropathy is considered as a poor prognostic finding.

Keywords: Acquired Immunodeficiency Syndrome/COMPLICATIONS Adult Aged Antibiotics/THERAPEUTIC USE Cranial Nerve Diseases/*ETIOLOGY Diabetes Mellitus/COMPLICATIONS English Abstract Female Human Male Mastoiditis/ETIOLOGY/SURGERY *Otitis Externa/COMPLICATIONS/DIAGNOSIS/DRUG THERAPY *Pseudomonas Infections/COMPLICATIONS/DIAGNOSIS/DRUG THERAPY JOURNAL ARTICLE
910630
M9160713

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