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

Abstract

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.

Chinese abstract

背景：恶性外耳炎是一种罕见但难治的严重疾病, 并多少会涉及到颅神经。

目的：检查导致患者面部麻痹的因素, 并明确对高危人群积极治疗的适应症。

材料和方法：在一项病例对照研究中, 对有和没有面瘫的139名患者进行了人口统计学、临床、实验室、听力测定、影像学和治疗特点等方面的分析。

结果：45例（32.4％）患有面瘫。与没有面神经受累的患者相比, 面瘫患者的炎症标记物发生率更高（入院时平均红细胞沉降率[67.71 vs. 51.16 mm / h], 总ESR的平均值[64.27 vs 54.46 mm / h], 以及平均C反应蛋白[38.96 vs 27.53 mg / L]）。还有, 面神经管（p <.01）和鼻咽间隙（p <.05）受累与面部麻痹的发生率有关。

结论：鼻咽部炎症可能与面神经管侵蚀可用作面神经功能障碍的预测指标。红细胞沉降率升高与面部麻痹风险增加相关。积极的药物治疗更为关键。

意义：改进对恶性外耳道炎患者预后的预测。

Keywords:

• Malignant otitis externa
• skull base osteomyelitis
• facial paralysis
• facial nerve involvement
• prognosis

Acknowledgements

This research was extracted from the thesis for the Doctor of Medicine degree at the Medical School of Tehran University of Medical Sciences (thesis number: 8911215155). This research was approved by the ethical committee of Tehran University of Medical Sciences (number: IR.TUMS.MEDICINE.REC.1397.516). We are honored to send our special thanks to the patients that medical science is based on the information they give us by their lives.

Disclosure statement

No potential conflict of interest was reported by the author(s).