SHM Converge Scientific Abstract ePoster Gallery-Not Ringing a Bell: Facial Palsy as the Initial Presentation of Malignant Otitis Externa With Cranial Nerve Involvement and Skull Base Osteomyelitis

Not Ringing a Bell: Facial Palsy as the Initial Presentation of Malignant Otitis Externa With Cranial Nerve Involvement and Skull Base Osteomyelitis

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This case describes a 58-year-old man with poorly controlled type 2 diabetes, hypertension, recurrent left ear infections, and a perforated tympanic membrane who presented with headache, left ear pain, facial weakness, and sudden vision loss. He was initially diagnosed with Bell’s palsy, but his broader symptoms and exam findings—left facial droop, afferent pupillary defect, complete left extraocular movement restriction, and left-sided blindness—suggested a more serious underlying process.<br /><br />Workup showed markedly elevated inflammatory markers (ESR 140, CRP 104) and cerebrospinal fluid abnormalities. Imaging revealed malignant otitis externa complicated by skull base and cervical osteomyelitis, otomastoiditis, and thrombosis of the left sigmoid sinus and internal jugular vein. MRI also showed involvement of the internal auditory canal, orbital apex, and optic nerve, while spinal imaging demonstrated enhancement in the C2-C4 vertebral bodies. A fungal cause, particularly Aspergillus, was suspected. This concern was strengthened by chart review showing a positive fungal ear culture from one year earlier that had not been further evaluated.<br /><br />The case highlights several diagnostic challenges. MOE can mimic more common conditions such as Bell’s palsy, migraines, or temporal arteritis, leading to delayed diagnosis. It emphasizes the importance of considering patient risk factors such as diabetes, chronic ear disease, tympanic membrane perforation, and possible occupational exposures. The authors stress avoiding anchoring bias and performing a thorough review of prior records.<br /><br />Clinical recommendations include rapid evaluation and treatment of diabetic patients with possible MOE to prevent severe complications, along with patient education on ear care and diabetes management.

Asset Subtitle

Ann Marie Kumfer

Meta Tag

Author List Ann Marie Kumfer, Bina Amin, Emma Healy

Category Clinical Vignettes

Concept Malignant Otitis Externa

Concept Skull Base Osteomyelitis

Concept Diabetes Mellitus

Concept Immunocompromised State

Concept Cranial Nerve Involvement

Distinguished Non-Finalist

Presenter Organization University of North Carolina Hospital

Presenting Author Ann Marie Kumfer

Track Adult

Keywords

malignant otitis externa

Aspergillus

diabetes mellitus

skull base osteomyelitis

facial palsy

vision loss

sigmoid sinus thrombosis

internal jugular vein thrombosis

tympanic membrane perforation

otitis externa

Malignant Otitis Externa

Skull Base Osteomyelitis

Diabetes Mellitus

Immunocompromised State

Cranial Nerve Involvement