scholarly journals A Case Series of Malignant Otitis Externa Mimicking Malignancy

2021 ◽  
Vol 64 (1) ◽  
pp. 36-41
Author(s):  
Vengathajalam Selvamalar ◽  
Nik Adilah Nik Othman ◽  
Mohd Khairi Daud
Keyword(s):  
Cranial Nerve ◽  
Otitis Externa ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Case Series ◽  
Lower Cranial Nerve ◽  
Cortical Mastoidectomy ◽  
Cranial Nerve Palsies ◽  
Adjacent Structures ◽  
Malignant Otitis Externa

Malignant otitis externa is an inflammation of the external auditory canal with preceding osteomyelitis of the temporal bone and the adjacent structures that could be potentially lethal. Malignant otitis externa may present with cranial nerve involvements and massive spread of disease mimicking nasopharyngeal carcinoma or any other malignancies on imaging. Two elderly patients who presented with severe otalgia and significant facial nerve palsy and lower cranial nerve palsies showing extensive spread of disease are reported in this case series. They both had resolution of disease after a prolonged course of antibiotics and cortical mastoidectomy for disease clearance in one of them.

scholarly journals Comprehensive management of malignant otitis externa with tuberculosis and cranial nerve paresis in geriatrics

2020 ◽  
Vol 50 (1) ◽  
pp. 77
Author(s):  
Ratna Dwi Restuti
Keyword(s):  
Diabetes Mellitus ◽  
Temporal Bone ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Otitis Externa ◽  
Nerve Palsy ◽  
Geriatric Patients ◽  
Cranial Nerve Palsies ◽  
Malignant Otitis Externa ◽  
Multiple Cranial Nerve

Background: Malignant otitis externa is an inflammatory condition of the external ear which has the propensity to spread to the skull base. It can be a difficult entity to treat as clinical presentation varies and response to treatment differs between patients. Purpose: Evaluating the management of malignant otitis externa with complications in geriatric patients who had multiple comorbidities. Case: A 71 years old female with a diagnosis of left malignant otitis externa with complications of multiple cranial nerve palsies (N.VII, IX, X) and comorbidity in the form of diabetes mellitus and chronic kidney disease. The patient underwent subtotal temporal bone resection and petrosectomy. Clinical Question: “Could surgical management of malignant otitis externa with cranial nerve palsies complication in geriatric patients with multiple comorbidities achieve better result than conservative treatment?” Review Method: Literature search using keywords ’malignant otitis externa’ OR ’temporal bone osteomyelitis’ AND ’geriatric’ OR ’elderly’ AND ’multiple cranial nerve palsy’ AND ’diabetes mellitus’ AND ’tuberculosis’ AND ’surgery’ OR ’surgical’ was conducted through Cochrane, Pubmed, and Google Scholar. Result: The search obtained 11 articles published in the last 10 years. Selection based on inclusion and exclusion criteria, 2 studies were found relevant with the topic. Conclusion: Management of malignant otitis externa with complications in geriatric patients with multiple comorbidities requires a multidisciplinary approach to determine the need for surgery intervention.Keywords: malignant otitis externa, cranial nerve palsy, subtotal temporal bone resection, geriatric, diabetes mellitus ABSTRAK Latar belakang: Otitis eksterna maligna adalah suatu kondisi peradangan pada telinga luar yang memiliki kecenderungan untuk meluas hingga ke dasar tengkorak. Penyakit ini menjadi sulit ditangani karena manifestasi klinis yang bervariasi dan respons terhadap pengobatan yang berbeda antara pasien. Tujuan: Mengevaluasi tatalaksana otitis eksterna maligna dengan komplikasi pada pasien geriatri yang memiliki komorbiditas multipel. Kasus: Pasien perempuan 71 tahun dengan diagnosis otitis eksterna maligna telinga kiri dengan komplikasi paresis saraf kranial multipel (n.VII, IX, X) dan penyakit penyerta berupa diabetes melitus dan gagal ginjal kronik. Pasien menjalani operasi reseksi tulang temporal subtotal dan petrosektomi. Pertanyaan klinis: “Apakah tatalaksana pembedahan memberikan hasil yang lebih baik dibandingkan terapi konservatif pada pasien geriatri dengan otitis eksterna maligna disertai paresis saraf kranialis dengan komorbiditas multipel.” Telaah Literatur: Dilakukan menggunakan kata kunci ’malignant otitis externa’ ATAU ’temporal bone osteomyelitis’ DAN ’geriatric’ ATAU ’elderly’ DAN ’multiple cranial nerve palsy’ DAN ’diabetes melitus’ DAN ’tuberculosis’ DAN ’surgery’ ATAU ’surgical’ pada beberapa sumber data seperti Cochrane, Pubmed, dan Google Scholar. Hasil: Didapatkan 11 artikel publikasi 10 tahun terakhir. Berdasarkan kriteria inklusi dan eksklusi diperoleh 2 artikel yang relevan dengan topik. Kesimpulan: Tatalaksana otitis eksterna maligna dengan komplikasi pada pasien geriatri dengan komorbiditas multipel, membutuhkan pendekatan multidisiplin terutama untuk menentukan perlunya dilakukan tindakan pembedahan.

scholarly journals Lower Cranial Nerve Palsies in the COVID-19 Pandemic: A 10-Case Series of Intensive Care Unit Patients

2021 ◽  
pp. 1-4
Author(s):  
Pierre Decavel ◽  
Olympe Nahmias ◽  
Carine Petit ◽  
Laurent Tatu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prone Position ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Case Series ◽  
University Hospital ◽  
Cranial Neuropathy ◽  
Lower Cranial Nerve ◽  
Cranial Nerve Palsies

<b><i>Introduction:</i></b> A number of neurological complications of COVID-19 have been identified, including cranial nerve paralyses. We present a series of 10 patients with lower cranial nerve involvement after severe COVID-19 infection requiring hospitalization in an intensive care unit. <b><i>Methods:</i></b> We conducted a retrospective, observational study of patients admitted to the post-intensive care unit (p-ICU) of Besançon University Hospital (France) between March 16 and May 22, 2020. We included patients with confirmed COVID-19 and cranial neuropathy at admission to the p-ICU. All these patients were treated by orotracheal intubation, and all but one underwent prone-position ventilation therapy. <b><i>Results:</i></b> Of the 88 patients admitted to the p-ICU, 10 patients (11%) presented at least 1 cranial nerve palsy. Of these 10 patients, 9 had a hypoglossal nerve palsy and 8 of these also had a deficit in another cranial nerve. The most frequent association was between hypoglossal and vagal palsies (5 patients). None of the patients developed neurological signs related to a global neuropathy. We found no correlation between the intensity of the motor limb weakness and the occurrence of lower cranial nerve palsies. All but 2 of the patients recovered within less than a month. <b><i>Conclusion:</i></b> The mechanical compressive hypothesis, linked to the prone-position ventilation therapy, appears to be the major factor. The direct toxicity of SARS-CoV-2 and the context of immune dysfunction induced by the virus may be involved in a multifactorial etiology.

Malignant otitis externa: case series

2010 ◽  
Vol 124 (8) ◽  
pp. 846-851 ◽  
Author(s):  
T Ali ◽  
K Meade ◽  
S Anari ◽  
M R ElBadawey ◽  
I Zammit-Maempel
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Otitis Externa ◽  
Nerve Palsy ◽  
Case Series ◽  
Case Review ◽  
Retrospective Case ◽  
North East ◽  
Malignant Otitis Externa

AbstractBackground:In the light of current concerns regarding ciprofloxacin resistance and the changing face of malignant otitis externa, we reviewed cases of malignant otitis externa treated in our centre, in order both to evaluate the current epidemiology of the condition and to assess the status of drug resistance in our patient population.Method:Retrospective case review of all malignant otitis externa cases managed in a tertiary referral centre in the north-east of England between 2000 and 2009.Results:Forty-one patients were identified, but the required data were available for only 37 cases. Patients' ages ranged from 51 to 101 years (median, 81 years). Diabetes was present in 51 per cent of patients (19/37), facial nerve palsy in 40 per cent (15/37) and multiple cranial nerve palsy in 24 per cent (9/37). Pseudomonas aeruginosa was the most commonly isolated organism (54 per cent), sensitive to ciprofloxacin in all cases.Conclusions:The incidence of cranial nerve palsy in our study was higher than in previous reports. The incidence of diabetes and Pseudomonas aeruginosa in our cohort was much lower than previously reported. The Pseudomonas aeruginosa strains isolated were all sensitive to ciprofloxacin, despite recent reports on emerging resistance.

scholarly journals Herpes zoster oticus with meningitis masquerading as malignant otitis externa

2019 ◽  
Vol 12 (6) ◽  
pp. e229569
Author(s):  
Harriet A Cunniffe ◽  
Nicholas G Cunniffe
Keyword(s):  
Otitis Externa ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Clinical Course ◽  
Abducens Nerve ◽  
Varicella Zoster ◽  
Seventh Cranial Nerve ◽  
Cranial Nerve Palsies ◽  
Malignant Otitis Externa

This is a case of an 85-year-old woman whom was admitted with otalgia and an abducens nerve palsy alongside a Pseudomonas otitis externa; she was presumed to have malignant otitis externa. However, despite optimum treatment and resolution of her otitis externa, she went on to develop an ipsilateral facial nerve palsy and sensorineural hearing loss. After further investigation, it was discovered that varicella-zoster meningitis was causing her polyneuropathy. She eventually responded to antivirals and steroids and, at follow-up, her sixth and seventh cranial nerve palsies had completely resolved, though a hearing deficit remained. This case highlights the importance of keeping a diagnosis under review, with the help of the multidisciplinary team, when the clinical course is not progressing as expected.

scholarly journals Endoscopic Removal of Skull Base Chordoma Type III through Single Skull Base Approach: Our Early Experience

2019 ◽  
Vol 9 (1) ◽  
pp. 57-63
Author(s):  
Shamsul Alam ◽  
Mohammad Sujan Sharif ◽  
Rathin Haldar ◽  
Anil Chaudhury ◽  
Abdullah Al Mahbub ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Skull Base ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Lower Cranial Nerve ◽  
Base Approach ◽  
Type Iii ◽  
Skull Base Approach ◽  
Skull Base Chordoma

Introduction: Skull base chordomas present with headache, commonly VI cranial nerve palsy or sometimes with lower cranial nerve involvement.Sometimes in neglected case it presents with complete blindness and facial nerve palsy. Case presentation: A 60-year old man presented with headache,visual disturbance progressing to blindness and facial nerve palsy. At first, radiological imaging showed large tumor which eroded his clivus, sella floor and involved both cavernous carotid more on left side,both ethmoid sinus,middle cranial fossa entension with transdural extension posteriorly. Conclusion: Patients who present with complete blindness and facial nerve palsy, endoscopic excision in a single skull base approach of a skull base chordoma type III is challenging and who developed visual improvement following surgery, has been highlighted in this report. Bang. J Neurosurgery 2019; 9(1): 57-63

scholarly journals Tongue Tied after Shoulder Surgery: A Case Series and Literature Review

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Molly B. Kraus ◽  
Rachel B. Cain ◽  
David M. Rosenfeld ◽  
Renee E. Caswell ◽  
Michael L. Hinni ◽  
...  
Keyword(s):  
Literature Review ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Case Series ◽  
Patient Positioning ◽  
Shoulder Surgery ◽  
Beach Chair Position ◽  
Tapia’S Syndrome ◽  
Cranial Nerve Palsies ◽  
Beach Chair

This article presents three cases of cranial nerve palsy following shoulder surgery with general anesthesia in the beach chair position. All patients underwent preoperative ultrasound-guided interscalene nerve block. Two cases of postoperative hypoglossal and one case of combined hypoglossal and recurrent laryngeal nerve palsies (Tapia’s syndrome) were identified. Through this case series, we provide a literature review identifying postoperative cranial nerve palsies in addition to the discussion of possible etiologies. We suggest that intraoperative patient positioning and/or airway instrumentation is most likely causative. We conclude that the beach chair position is a risk factor for postoperative hypoglossal nerve palsy and Tapia’s syndrome.

scholarly journals A Case of Transient, Isolated Cranial Nerve VI Palsy due to Skull Base Osteomyelitis

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Brijesh Patel ◽  
Anas Souqiyyeh ◽  
Ammar Ali
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Facial Pain ◽  
Otitis Externa ◽  
Skull Bone ◽  
Topical Antibiotics ◽  
Skull Base Osteomyelitis ◽  
Cranial Nerve Palsies ◽  
Malignant Otitis Externa ◽  
The Common

Otitis externa affects both children and adults. It is often treated with topical antibiotics, with good clinical outcomes. When a patient fails to respond to the treatment, otitis externa can progress to malignant otitis externa. The common symptoms of skull bone osteomyelitis include ear ache, facial pain, and cranial nerve palsies. However, an isolated cranial nerve is rare. Herein, we report a case of 54-year-old female who presented with left cranial nerve VI palsy due to skull base osteomyelitis which responded to antibiotic therapy.

Malignant Otitis Externa (MOE) causing cerebral abscess and facial nerve palsy

2010 ◽  
Vol 5 (7) ◽  
pp. E6-E8 ◽  
Author(s):  
John Roberts ◽  
Línea Larson-Williams ◽  
Farrah Ibrahim ◽  
Ali Hassoun
Keyword(s):  
Facial Nerve ◽  
Otitis Externa ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Cerebral Abscess ◽  
Malignant Otitis Externa

Masked pseudomonal skull base osteomyelitis presenting with a bilateral Xth cranial nerve palsy

2002 ◽  
Vol 116 (7) ◽  
pp. 556-558 ◽  
Author(s):  
R. G. Rowlands ◽  
G. K. Lekakis ◽  
A. E. Hinton
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Jugular Foramen ◽  
Radiological Investigation ◽  
Lower Cranial Nerve ◽  
Skull Base Osteomyelitis ◽  
Cranial Nerve Palsies ◽  
Focus Of Infection

Skull base osteomyelitis classically presents as a complication of severe external otitis, middle ear, mastoid or sinus infection and can lead to multiple lower cranial nerve palsies when the jugular foramen is involved as a consequence of widespread involvement of the skull base. Bilateral skull base osteomyelitis is a recognized phenomenon, but has not previously been reported secondary to pseudomonal infection in the absence of a clinically obvious focus of infection. We report the case of a 77-year-old diabetic patient who presented with dysphonia and dysphagia and had a bilateral Xth cranial nerve palsy. No focus of infection was evident on presentation. Subsequent radiological investigation confirmed the diagnosis of bilateral skull base osteomyelitis.

A case of malignant otitis externa following mastoidectomy

1999 ◽  
Vol 113 (12) ◽  
pp. 1095-1097 ◽  
Author(s):  
S. K. Patel ◽  
D. W. McPartlin ◽  
J. M. Philpott ◽  
S. Abramovich
Keyword(s):  
Granulation Tissue ◽  
Cranial Nerve ◽  
Otitis Externa ◽  
Cranial Nerves ◽  
Complete Recovery ◽  
Jugular Bulb ◽  
Intravenous Antibiotics ◽  
Cranial Nerve Palsies ◽  
Malignant Otitis Externa ◽  
Nerve Paresis

AbstractWe present a case of a 63-year-old diabetic male who developed malignant otitis externa following mastoidectomy. Extensive skull base osteomyelitis caused thrombosis of the jugular bulb and subsequent paralysis of cranial nerves VII, IX, X and XII. Hewas treated aggressively with intravenous antibiotics and debridement of granulation tissue in the mastoid bowl with full recovery of the cranial nerve palsies associated with recanalization of the jugular bulb. We believe this is the first reported case of malignant otitis externa to occur following mastoidectomy with complete recovery of the cranial nerve paresis.

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