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.