Necrotizing Otitis Externa

Abstract

Objective: Evaluate the cases of necrotizing otitis externa (NOE) with regard to gender, mean age, comorbidities, clinical presentation, involvement of cranial nerve and its resolution, isolated germs at culture of swabs or biopsies of EAM, and findings at image evaluation.

Method: The patient presented severe otalgia, auricular plenitude and right peripherical facial palsy. He submitted to a swab test and also to a biopsy of the external auditory meatus. Other examinations were requested: a complete blood count, C-reactive protein, a mastoid computer tomography, and mastoid scintigraphy.

Results: Ten patients were evaluated, 4 of them were women and 6 men. All of them had type II diabetes. The most common initial finding was external meatus polyps (90% of the cases), followed by cranial nerve palsy (50% of the cases). There was complete remission of that palsy in 51% of the cases, incomplete remission in 16%, and no remission in 33% after treatment. In most of the cases, Pseudomonas aeruginosa was found (60%). Mastoid and external auditory meatus alterations were the most common disturbance in computed tomography.

Conclusion: This case reports a patient with a cellular immunosuppression disease which appeared to have an NOE complicated by cranial nerve paralysis based on his clinical picture and complementary evaluation except for the scintigraphy study. The histopathological analysis revealed a neoplastic etiology for the ear involvement.