What are the morbidities of malignant otitis externa (MEO)?

Updated: Apr 13, 2020
  • Author: Brian Nussenbaum, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Cranial nerves can be affected by inflammation along the skull base or by a neurotoxin produced by Pseudomonas species. The facial nerve (VII) is affected most commonly, usually at the stylomastoid foramen. As the disease progresses, cranial nerves IX, X, and XI can be affected at the jugular foramen, followed by XII at the hypoglossal canal. Cranial nerves V and VI can be affected if the disease extends to the petrous apex.

In 1977, Chandler reported a 32% incidence of facial nerve paralysis. [5] The incidence of facial nerve paralysis appears to have decreased with the development of more effective medical therapy as shown by Franco-Vidal et al who reported a 20% incidence of facial nerve paralysis in 46 treated patients. [6] The other cranial nerves are affected less frequently than the seventh cranial nerve. The development of cranial neuropathy generally was thought to reflect advanced-stage disease associated with a worse prognosis. More recently, Corey et al, Soudry et al, and Mani et al suggested that the presence of facial nerve paralysis does not worsen the prognosis. [7, 8] Recovery of facial nerve function is poor and unpredictable, and should not be used as an indicator of successful treatment. Other cranial nerves that are affected have a higher rate of recovery.


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