Endocrine Abstracts

Introduction: Necrotizing otitis externa (NOE) is an invasive infection. It may present with a variety of clinical findings. The most common symptoms are purulent otorrhea and exquisite otalgia resistant to analgesics. Diabetics are susceptible to microangiopathy that dulls pain perception thus predisposing them to severe complications of inctious disease.

Materials and methods: We reported ten cases of complicated necrotizing otitis externa in diabetic patients treated in ENT department of Tahar Sfar Hospital in Tunisia.

Non diabetic patients were excluded.

Results: Ten patients were diabetic occuring in 6 women and 4 men. The mean age was 64 years ranging from 58 years to 71 years. The average duration of diabetes follows up was over 10 years. All patients have received oral and local antibiotics before hospitalization. Symptoms were made of otalgia in all patients, otorrhea in 6 patients. Headache and temporo–mandibular joint pain were reported in two cases. Fever was observed in four patients. Four patients noted ipsilateral facial palsy. Stenosis of external auditory canal was observed in all patients Pseudomonas aeruginosa was t isolated in 9 cases and candidada albicans in one case. Computed tomography confirmed the NOE in all cases. CT scan showed also an extension to parapharyngeal space in 2 cases with a huge abcess in one case, to the rhinopharynx in one case, temporomandibular arthritis in two cases, lysis of the skull base in one case, lysis of the facial canal in two cases, sigmoid sinus thrombosis in one case and jugular vein thrombosis in two cases. MRI was performed for two cases with extension to parapharyngeal space and to the rhinopharynx. Diabetic control worsened with the onset of invasive external otitis in all cases. Nine patients have received intravenous anti–pseudomonal medications. Antifungual therapy was conducted in one case. One patient had a drainag of retropharyngeal abcess. Heparin was not used for the cases of septic thrombosis. A regression of symptoms was observed in 8 cases and two patients had facial palsy as sequalae.

Conclusion: Necrotizing otitis externa remains a devastating infection due to its complications. Always think about it, especially in diabetics, in order to get adequate treatment in time and prevent complication. Adequate control of diabetes in association with antibiotic therapy must be started quickly to reduce morbidity and mortality.