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Hypoglossal paresis as the only complication of malignant otitis externa.

BACKGROUND
Ipsilateral hypoglossal nerve (XII) paresis has never been reported as the first and only complication of malignant otitis external (MOE).


CASE REPORT
A 73-year-old diabetic male with persistent left temporomandibular joint ache and ear fullness was admitted with the diagnosis of MOE. He received intravenous ciprofloxacin for 14 days and then continued with oral administration (per os). After two months, he returned with otalgia, swallowing difficulty, and ipsilateral XII paresis. He was re-admitted, received intravenous ciprofloxacin for 6 weeks, and continued with per os ciprofloxacin for 6 months. A Ga67-scan 6 months after the first admission revealed no active infection. Two years after his last admission, the patient still has XII paresis. There is no other cranial nerve involvement and inflammatory markers continue to be normal.


CONCLUSION
Doctors should consider MOE in the differential diagnosis when there is XII paresis, especially in diabetic and immunocompromised patients.