CASE REPORT   

Otorinolaringologia 2019 December;69(4):224-8

DOI: 10.23736/S0392-6621.19.02232-X

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Unusual case of VIII nerve dysfunction on necrotizing external otitis

Diogo A. PEREIRA ¹ ✉, Luís GUEDES ², Abílio LEONARDO ¹, Delfim DUARTE ¹, Gustavo LOPES ¹

¹ ENT Department, Hospital Pedro Hispano, Matosinhos, Portugal; ² Public Health Department, ULS Matosinhos, Matosinhos, Portugal

Skull base osteomyelitis is a rare disease which usually complicates a necrotizing external otitis with temporal bone involvement. Classically, it affects diabetic and immunocompromised male patients and has a high mortality rate, up to 20%. A 66-year-old diabetic male was evaluated for a skull base osteomyelitis originated by Pseudomonas aeruginosa with VIII pair involvement. The patient was treated with long term ceftazidime, hyperbaric oxygen therapy, meticulous glycemic control and aural toilet. A 66-year-old Caucasian male came to our emergency room with left earache and purulent otorrhea, previously diagnosed with an acute external otitis and unsuccessfuly medicated with a topic antibiotic (neomicine, dexamethasone, polymixine B) and oral ciprofloxacine for 2 weeks. He was then admitted for a week, medicated with endovenous ciprofloxacin and topical ofloxacine with resolution of the earache and the discharge; 3 months after, he recurred again to our emergency room with headache, left earache, left hypoacusis and complaining of progressive imbalance, without otorrhea. He undergone ear MRI which revealed osteomyelitis located on left petrous apex; a skull base osteomyelitis was diagnosed as a result of a necrotizing external otitis with VIII cranial nerve disfunction. He was again admitted with a rigorous glycemic control, ceftazidime 2g 8-8h and hyperbaric oxygen therapy; After 16 weeks of parenteral antibiotic treatment, the patient was discharged, and treatment was continued with oral ciprofloxacin for 4 months, leading to a radiological complete response. Skull base osteomyelitis is a dangerous condition; Clinical suspicion and correct microbiological identification are key to favorable outcomes. In this report, we present an uncommon case of only VIII pair commitment and a nonlinear clinical history, which in some cases can precipitate a wrong approach. The clinical suspicion is of incommensurable value, as it is the fast treatment. There are no guidelines on Skull base osteomyelitis treatment but is almost consensual that endovenous antibiotic treatment directed to the isolated agent, ototopic antibiotic drops and rigorous glycemic control may have a central role on the treatment. The role of hyperbaric oxygen therapy is still unclear; nonetheless some studies propose that can potentiate the antibiotic treatment.

KEY WORDS: Osteomyelitis; Hyperbaric oxygenation; Vestibulocochlear nerve injuries