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

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.

Facial nerve paralysis in malignant otitis externa: comparison of the clinical and paraclinical findings.

BACKGROUND: Malignant otitis externa is an uncommon but critical challenging disease with some degree of cranial nerve involvement. AIM/OBJECTIVE: to examine the factors leading to facial paralysis in these patients and clarify indications for aggressive treatment in the group most at risk. MATERIAL AND METHODS: In a case-control study, demographic, clinical, laboratory, audiometric, imaging, and treatment characteristics of 139 patients in groups with and without facial paralysis were analysed. RESULTS: 45 patients (32.4%) had facial paralysis. Compared to patients without facial nerve involvement, patients with facial palsy had a higher rate of inflammatory markers (mean erythrocyte sedimentation rate on admission [67.71 vs 51.16 mm/h], and the average of total ESR [64.27 vs 54.46 mm/h], as well as the mean C-reactive protein [38.96 vs 27.53 mg/L]). Also, the involvement of the facial canal (p < .01) and nasopharyngeal space (p < .05) were related to the incidence of facial paralysis. CONCLUSION: Nasopharyngeal extension of the inflammation and facial nerve canal erosion might be useful as predictors of facial nerve dysfunction. The elevated erythrocyte sedimentation rate is correlated with the increased risk of facial paralysis, and aggressive medical management is more crucial. SIGNIFICANCE: Improvement in predicting the outcome of patients with malignant otitis externa.

Diabetes mellitus and cognitive impairments.

There is strong evidence that diabetes mellitus increases the risk of cognitive impairment and dementia. Insulin signaling dysregulation and small vessel disease in the base of diabetes may be important contributing factors in Alzheimer's disease and vascular dementia pathogenesis, respectively. Optimal glycemic control in type 1 diabetes and identification of diabetic risk factors and prophylactic approach in type 2 diabetes are very important in the prevention of cognitive complications. In addition, hypoglycemic attacks in children and elderly should be avoided. Anti-diabetic medications especially Insulin may have a role in the management of cognitive dysfunction and dementia but further investigation is needed to validate these findings.