Malignant Otitis Externa with Skull Base Extension

Introduction: Malignant otitis externa (MOE) is a serious, invasive infection of the external auditory canal, increasingly seen in patients who are immunocompromised, potentially lethal if delayed diagnosis or inadequate treatment. The extension to the skull base is a dreadful complication that can be fatal. Objective: To study the epidemiological, clinical, and therapeutic OEM with extension to the skull base. Material and Methods: We undertook a retrospective study of eight cases of MOE with extension to the skull base, treated at the ENT department at the military hospital in Tunis over a period of 12 years, from 2002 to 2013. Results: The study included eight patients, six of which were men, aged older than 60 years in seven cases. All patients were diabetic. The most common chief complaint was persistent otalgia associated in three cases with otorrhea. Facial palsy was noted in three patients. All patients received computed tomography (CT scan) examination, and it revealed filling of the middle ear and erosion of the skull base. All the patients received empiric parental antibiotics with a mean duration of 44 days, relayed by oral treatment. The outcome was favorable in only three patients. Conclusion: Malignant otitis externa is a potentially fatal infection that affects mostly the old and diabetic subject. The extension to the skull base aggravates considerably the prognosis as soon as possible.