Cranial nerve palsy prevalence and associated factors in patients with malignant otitis externa

Abstract

Objective To identify the prevalence of cranial nerve (CN) palsy and its associated factors in malignant otitis externa (MOE). Methods In a retrospective study, records of MOE patients from 2011 to 2014 were reviewed. MOE and CN involvement were evaluated based on patient demographics, clinical, and paraclinical data. Results Overall, 119 MOE patients with a mean age of 65.9 ± 11.3 were included. 69.7% were male, and 63.0% had a history of diabetes. The most common symptoms and signs were otalgia (97.5%), otorrhea (44.5%), and ear canal erythema/edema (24.4%). Thirty‐three patients (27.7%) had CN involvement. The facial nerve was mostly involved (26.1%). Skull base osteomyelitis (SBO) was present in 59 patients. When excluding patients younger than 30 and older than 80, age decade was correlated with CN palsy. 66.9% of patients with CN palsy and 65.6% without CN palsy were male, which was significantly different. The following factors were not significantly different between patients with and without CN palsy: Comorbidities, signs and symptoms, diagnostic delay, erythrocyte sedimentation rate level, fasting blood sugar, hemoglobin A1c level, antifungal therapy, hospitalization duration, and SBO on imaging. Tinnitus was correlated with SBO evidence on imaging (specificity: 96.7%). Conclusion CN involvement occurs in about three out of 10 MOE patients. Male gender and advanced age may be related to a higher incidence rate of CN palsy. Tinnitus can be a specific indicator of SBO. These findings could help in better decision‐making for early interventions. Level of Evidence 4.

Are artificial intelligence large language models a reliable tool for difficult differential diagnosis? An a posteriori analysis of a peculiar case of necrotizing otitis externa

“…It is a severe infection of the external ear canal that can progress to involve the temporal bone and adjacent structures. The diagnosis of NOE presents significant challenges due to its insidious onset, nonspecific initial symptoms, and the potential for serious complications, which can include cranial nerve palsies and intracranial involvement 1 …”

“…The diagnosis of NOE presents significant challenges due to its insidious onset, nonspecific initial symptoms, and the potential for serious complications, which can include cranial nerve palsies and intracranial involvement. 1 Patients with NOE typically present with persistent ear pain, often out of proportion to the physical examination findings, and may also have otorrhea or hearing loss. However, these symptoms are also common in less severe conditions, which can lead to misdiagnosis and delayed treatment.…”

“…The diagnosis of NOE presents significant challenges due to its insidious onset, nonspecific initial symptoms, and the potential for serious complications, which can include cranial nerve palsies and intracranial involvement. 1 …”