851 Necrotising Otitis Externa Secondary to Ear Syringing in an Otherwise Healthy Patient: A Case Report

Abstract

Abstract Introduction Unrelenting unilateral otalgia in an elderly or diabetic or immunocompromised patient is clinically suspicious for necrotising otitis externa (NOE). This is an advancement of normal diffuse OE that can complicate into a number of severe neurological pathologies, and it is becoming increasingly common1. We report a case here of NOE that became acutely apparent following ear syringing, due to the introduction of micro-organisms into the external auditory canal (EAC). Literature review shoes only 3 previous articles that have explored this pathological link. Case presentation A lady in her 90s with no known diabetes or immunocompromise, presented with a combination of otalgia, otorrhea and profound hearing loss. This plethora of symptoms had developed and persisted following ear syringing she underwent for chronic wax impaction. A diagnosis of NOE was made based on the clinical symptoms, presence of a polyp on the anterior aspect of the external auditory canal (EAC) as well as positive Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) findings. Prompt administration of intravenous (IV) antibiotics was initiated in addition to biopsy of the polyp to send for histological analysis. Her overall clinic status improved, and she was ultimately discharged with a prolonged IV antibiotic course alongside outpatient antibiotic team (OPAT) support and advice given on the avoidance of ear syringing/aural irrigation or at least a reduction in frequency of its use. Conclusions This rare case emphasises the significance of ear syringing in precipitating NOE by the transmission of Pseudomonas aeruginosa via irrigation fluid or lavage instrumentation.