Author(s)
Woo Yul Byun, BSE
Lisa Zhang, MD
Joseph F. Bonanno, BS
Stephanie S. Wentzel, BS
Yin Ren, MD PhD
Affiliation(s)
Ohio State University College of Medicine;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to determine objective patient characteristics that identify patients with malignant otitis externa (MOE) who are at risk of developing severe disease requiring inpatient admission.
Objectives: To elucidate objective presenting characteristics of patients who, on average, require inpatient care for MOE.
Study Design: Retrospective chart review.
Methods: The charts of adult patients who presented to a tertiary academic referral center or affiliated clinics and were diagnosed with MOE between 2010-2022 were reviewed. The demographics, past medical history, history of present illness, inpatient or outpatient courses, and followup visits of 23 patients (mean age 68 [SD = 13], 78% male) were recorded.
Results: 18 were admitted and 5 were treated as outpatients. Facial nerve dysfunction (House-Brackmann grades II-VI) was significantly more common in admitted patients (56% vs. 0%, P = 0.046). Additionally, the average duration of symptoms before presentation was significantly lower in admitted patients (38 days [SD = 42] vs. 165 days [SD = 219], P = 0.032). In contrast, there were no significant differences in the presence of ear discharge (P = 0.621), renal disease (P = 0.272), insulin use (P = 0.127), and whether the patient presented to the emergency department instead of outpatient clinic (P = 0.155).
Conclusions: Patients who required inpatient admission for MOE had higher incidence of facial nerve dysfunction and shorter duration of symptoms compared to those who did not require admission. In addition, there is a trend that insulin use and presenting first to the emergency department may be additional factors that need to be considered. These preliminary findings may serve as guidance to primary care physicians and general ENT practitioners to identify the population most at risk for developing severe MOE and improve patient triage. Analysis of additional patients may better depict significant patient characteristics.