The patient has a history of diabetes, severe ear pain, deep night,otoree purulent, dysphagia, hoarseness and inflammatoryfaciala.Modificarile dysfunction are observed in the external ear canal and soft tissue periauricular. The pain is disproportionate to the clinic discovered. Marked sensitivity is present in soft tissue of the mandible and mastoid branches. Granulation tissue is presenton the floor osteocartilaginous junction. This item ispathognomonic for malignant otitis externa. Otoscope exam mayshow exposed bone.
Requires examination of cranial nerves, mental status must also beexamined, may indicate a deterioration intracranial complication.Tympanic membrane is usually intact. Fever is unusual.
Cranial nerve impairment indicates a negative prognosis. Death isdue omplicatiilor intracranial sigmoid sinus thrombosis as well asfrom complications of treatment: bone marrow suppressioninduced by long-term antibiotic therapy. The prognosis is affectedby comorbid conditions that are common in patients who developmalignant otitis externa.
Family physicians should be suspicious for this disease in immunocompromised patients with otitis externa. When externalotitis is refractory to treatment and patients accused severeotalgia, especially at night warning signs are drawn.
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