Necrotizing Otitis Externa: A Disease Barely Known to Neurosurgeons

Necrotizing otitis externa (NOE), also known as malignant otitis externa (MOE), is a severe and rare infectious disease of the external auditory canal (EAC). Without treatment, it may progress to skull base involvement. The bacteria Pseudomonas aeruginosa is the most common causative agent (90% of the cases), and affects immunocompromised subjects, particularly diabetic patients. Severe chronic otalgia, otorrhea, and cranial nerve palsy are the most common clinical presentations. Patients with NOE are frequently referred to neurosurgery because of the neurological impairment and skull base compromise. The definitive diagnosis is frequently elusive, requiring a high index of suspicion. Several laboratorial tests, imaging modalities, and the histologic exclusion of malignancy may be required. An early diagnosis and aggressive treatment reduce morbidity and mortality. We present four NOE cases to illustrate the spectrum of clinical presentation and complementary exams. According to the literature, more effort for early diagnosis and treatment is required, and neurosurgeons play an important role in this task.

Plasma fibronectin level in malignant external otitis

This study was carried out on twenty diabetic patients [10 had malignant external otitis, and 10 were under medical control] in a trial to find out any relationship between plasma fibronectin level and severity of malignant external otitis infection. Plasma fibronectin was significantly high in cases of malignant external otitis compared to uncomplicated diabetic cases and normal individuals. Plasma fibronectin was positively correlated with blood glucose level and with the severity of the disease as detected by radionuclide imaging; also it was significantly increased in cases of malignant external otitis compared to the same cases after treatment or in diabetic cases under medical control. Therefore, the degree of increase of plasma fibronectin level can be considered as a parameter reflecting the severity of malignant external otitis. On the other hand, a decrease of its level indicates heading of malignant external otitis. However, trial for evaluating the therapeutic efficacy of exogenous fibronectin in promoting healing of malignant external otitis might be recommended as a future research

Otorragia persistente en pacientes con carcinoma prostático diseminado / Persistent external auditory meatus hemorrhage in a patient with disseminated prostatic carcinoma

Otorragia en paciente masculino de 77 años en mal estado general, visto en la consulta de O.R.L. por 12 horas de sangrado por conducto auditivo derecho. Se hizo taponamiento compresivo con gasa con adrenalina y cuidados médicos generales, a peras de lo cual siguió sangrando dos días mas. Estudios radiológicos, audiológicos y con microscopio descartaron tumor y hemotímpano; el cuadro semejaba la otitis externa hemorrágica descrita por Mawson. Exámenes de laboratorio manifestaron hipoplasia medular y la consulta urológica reveló adenocarcinoma prostático con metástasis diseminadas no accesibles a tratamiento. El estado general del paciente continuó deteriorándose y falleció poco después. No se efectuó autopsia y no fue posible determinar anatómicamente la causa del sangrado; se concluyó que fue una otitis externa hemorrógica en pacientes imunodeprimido y con hipoplasia medular por adenocarcinoma prostático con metástasis generalizadas