# Type 2 Diabetes Mellitus With Complex Necrotizing Otitis Externa, Skull Base Osteomyelitis, and Cranial Nerve Palsies: A Case Report

## TL;DR

A diabetic patient developed a severe ear infection that spread to the skull base and nerves, requiring intensive treatment and highlighting the need for early diagnosis and multidisciplinary care.

## Contribution

This case report emphasizes the management of complex necrotizing otitis externa in diabetic patients through a multidisciplinary approach and culture-guided treatment.

## Key findings

- The patient showed ciprofloxacin-resistant Pseudomonas aeruginosa and cranial nerve palsies.
- MRI and histology confirmed necrotizing inflammation and granulation tissue.
- Multidisciplinary treatment led to improved outcomes but persistent hearing loss.

## Abstract

Necrotizing otitis externa (NOE) is a severe infection of the external auditory canal that can extend to the skull base. We report the case of a 67-year-old gentleman with insulin-dependent type 2 diabetes mellitus with suboptimal glycemic control who presented with a likely complex NOE. Initial findings included ciprofloxacin-resistant Pseudomonas aeruginosa, elevated inflammatory markers, and multiple cranial nerve palsies. MRI revealed the presence of granulation tissue at the osseocartilaginous junction. Histology from the right external auditory canal confirmed the presence of necrotizing acute inflammation. A multidisciplinary approach was used to treat the patient, which included intravenous antibiotics (ceftazidime), strict glycemic control, and right tarsorrhaphy. This resulted in significant improvement, with normalization of inflammatory markers and resolution of cranial nerve palsies, though hearing loss persisted. This case highlights the importance of early diagnosis, culture-guided antibiotic therapy, and a multidisciplinary treatment strategy in managing NOE, particularly in patients with diabetes mellitus. Extended monitoring is crucial to prevent recurrence.