Cranial nerve involvement in malignant external otitis: implications for clinical outcome.
BACKGROUND
Malignant external otitis is an uncommon, potentially lethal infection of the temporal bone primarily affecting elderly diabetic patients.


OBJECTIVE
To determine whether cranial nerve involvement in malignant external otitis affects or predicts the clinical outcome in terms of morbidity and mortality.


METHODS
Diagnosis of malignant external otitis was established in 23 patients (average age, 71 yr; range, 39-87) based on inclusion criteria of severe pain, otitis externa refractory to conventional treatments, diabetes mellitus, and Pseudomonas aeruginosa detection. Computed tomography confirmed temporal bone involvement extending outside the external auditory canal.


METHODS
Retrospective analysis of hospital records.


RESULTS
Ten of 23 (43.5%) patients showed cranial nerve involvement. The following cranial nerves were affected: facial nerve (6/10), lower cranial nerves (combination of IX, X, XI, XII) (3/10), and extended nerve palsy (VI, VII, IX, X, XI) (1/10). Thirteen of 23 (56.5%) patients displayed no cranial nerve involvement. All patients were treated with long-term, high-dose antibiotic treatment dependent on the microbiological findings.


CONCLUSIONS
All patients with lower cranial nerve palsy recovered normal function; however, the facial nerve palsy was significantly less likely to improve by medical treatment. Cranial nerve involvement did not affect the patient survival rate under an optimized medical treatment in our series.
Mani
Navin
N
Department of Otolaryngology and Skull Base Surgery, Addenbrooke's Hospital, Cambridge, UK.
Sudhoff
Holger
H
Rajagopal
Sandeep
S
Moffat
David
D
Axon
Patrick R
PR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D003391:Cranial Nerves / Q000473:pathology*; D048909:Diabetes Complications / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D010032:Otitis Externa / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D012189:Retrospective Studies; D019291:Skull Base / Q000000981:diagnostic imaging / Q000473:pathology; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
D000890:Anti-Infective Agents