Endocrine Abstracts

Introduction: Necrotizing otitis externa is an invasive infection of the external auditory canal and skull base, which typically occurs in older adult patients with diabetes mellitus.

Objective: The purpose of this work is to describe the complications related to necrotizing otitis externa among patients with diabetes.

Methods: This is a retrospective study including 10 diabetic patients with complicated necrotizing otitis externa treated in our ENT department.

Results: Our study included 4 men and 6 women. The mean age was 64 years ranging from 58 to 71 years. The average duration of diabetes follow-up was 10 years. All patients have received oral and local antibiotics before hospitalization. Symptoms were made of otalgia in all patients and otorrhea in 6 patients. Headache and temporo-mandibular joint pain were reported in 2 cases. Fever was observed in 4 patients. Four patients noted ipsilateral facial palsy. Stenosis of external auditory canal was observed in all patients. Pseudomonas Aeruginosa was isolated in 9 cases and Candidada Albicans in one case. CT-scan confirmed the diagnosis of necrotizing otitis externa in all cases. It also showed: an extension to parapharyngeal space in 2 cases, an extension to the rhinopharynx in one case, temporomandibular arthritis in 2 cases, lysis of the skull base in one case, lysis of the facial canal in 2 cases, sigmoid sinus thrombosis in one case and jugular vein thrombosis in 2 cases. MRI was performed in 2 cases showing the extension to parapharyngeal space and to the rhinopharynx. Diabetic control worsened with the onset of the infection in all cases. Nine patients received intravenous anti-pseudomonal medications. Antifungal therapy was conducted in one case. One patient had drainage of the retropharyngeal abscess. Symptoms disappeared in 8 cases and 2 patients had facial palsy as a sequel.

Conclusion : Necrotizing otitis externa is characterized by its aggressive behavior and its difficulty of management, especially among diabetic patients. Early diagnosis, adequate control of diabetes in association with early antibiotic therapy can reduce the morbidity and mortality of this disease.