ear, nose, and throat disorders
Malignant External Otitis
Introduction
Malignant external otitis, also referred to as skull base osteomyelitis or necrotizing otitis externa, is typically aPseudomonasosteomyelitis of the temporal bone. Methicillin-resistantStaphylococcus aureus(MRSA) has also been reported as a cause. Soft tissue, cartilage, and bone are all affected by malignant external otitis. The osteomyelitis spreads along the base of the skull and may cause Overview of Neuro-ophthalmologic and Cranial Nerve Disorders (VII usually affected first followed by IX, X, and XI) and may cross the midline. ( Antibiotic resistance ) has also been identified as a cause. It is characterized by persistent and severe, deep-seated ear pain (often worse at night), foul-smelling purulent otorrhea, and granulation tissue or exposed bone in the ear canal (usually at the junction of the bony and cartilaginous portions of the canal). Varying degrees of conductive hearing loss may occur. In severe cases, facial nerve paralysis, and even lower cranial nerve (IX, X, or XI) paralysis, may ensue as this erosive, potentially life-threatening infection spreads along the skull base (skull base osteomyelitis) from the stylomastoid foramen to the jugular foramen and beyond. 