# An Unusual Presentation of Nectrotizing Otitis Externa in an Elderly Patient

## TL;DR

This case report describes a rare and severe presentation of necrotizing otitis externa in an elderly patient, leading to life-threatening complications.

## Contribution

The paper presents an unusual clinical case of NOE with multiple cranial nerve palsy and highlights diagnostic and management challenges in frail elderly patients.

## Key findings

- NOE was diagnosed in an 83-year-old man with subtle cranial nerve palsy and a history of otitis externa.
- CT scans revealed skull base osteomyelitis, sigmoid sinus thrombosis, and intracerebral abscess.
- The patient's frailty limited surgical options, and he succumbed to the disease despite antibiotic treatment.

## Abstract

Necrotizing otitis externa (NOE) is a rare but life-threatening condition that can often be challenging to diagnose. In this case report, we describe a rare presentation of NOE in an 83-year-old man with subtle signs of multiple unilateral cranial nerve palsy (VII, VIII, IX, X, XII). Prior to this, he had a three-month history of bilateral otitis externa, managed with topical and oral antibiotics. NOE was confirmed on CT head, which revealed left-sided skull base osteomyelitis (SBO). A repeat CT scan revealed left sigmoid sinus thrombosis and intracerebral abscess, indicative of disease progression. He was treated with ototopic and long-term systemic antipseudomonal antibiotics but unfortunately he was too frail, with a Clinical Frailty score (CFS) of 7, for further surgical management. The disease progressed despite ward-based treatment and he sadly passed away.