A Case of Malignant Otitis Externa with Facial Nerve Palsy

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  • 顔面神経麻痺を伴った悪性外耳道炎例
  • ガンメン シンケイ マヒ オ トモナッタ アクセイ ガイジドウエンレイ

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Abstract

<p>Malignant otitis externa (MOE), an invasive infection of the external auditory canal and skull base, typically occurs in elderly patients with diabetes mellitus. The most common causative agent is said to be Pseudomonas aeruginosa, but other species of bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), have been implicated. Common presenting symptoms of MOE include otalgia, otorrhea, aural fullness, and hearing loss. Facial paralysis may occur depending on the extent of progression of the disease. Herein, we report a patient with malignant otitis externa who presented with otorrhea and facial palsy.</p><p>An 86-year-old female patient with a history of diabetes mellitus, heart failure, and undergoing maintenance hemodialysis due to diabetic nephropathy presented with a history of otorrhea and otalgia. Her symptoms failed to improve despite treatment with cephem antibiotics and ofloxacin ear drops, and she developed left facial paralysis two weeks after the start of treatment. She was referred to a general hospital for computed tomographic imaging, which revealed thinning of the tegmental wall; therefore, the patient was referred to our hospital for further treatment. Pseudomonas aeruginosa was cultured from the otorrhea fluid. Based on the clinical course, we made the diagnosis of MOE. On day 4 of hospitalization, mastoidectomy was performed to establish drainage, remove granulation tissue from the middle ear, and obtain a specimen for detecting evidence of malignancy. After six weeks of intravenous antibiotic treatment, while her facial paralysis remained persistent, the otalgia and otorrhea resolved, with no signs of recurrence to date.</p><p>Antibiotic treatment is the standard treatment for MOE. If the patient fails to respond sufficiently to conservative treatments, surgical intervention should be considered. In the present case, surgery was performed 4 days after hospitalization, which led to prompt resolution of the otorrhea and otalgia.</p>

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