Advanced necrotizing external otitis treated by suboccipital craniectomy.

Necrotizing external otitis is a destructive infection caused by Pseudomonas aeruginosa. It may spread to surrounding soft tissue, cartilage and bone from the skin of the external canal and cause cranial nerve palsy. Most of the disease occurs in elderly diabetics and is accompanied by high mortality in an extended case in spite of intensive antibiotic therapy. A case of advanced necrotizing external otitis with palsies of VI to XII cranial nerves was presented. The patient, 69-year-old male, took a favorable course after complete debridement by suboccipital craniectomy followed by intensive antibiotic therapy. This procedure was performed by co-operation with a neurosurgeon. Characteristics of the pathology, criteria for the diagnosis and method of treatment are discussed; the authors stress the importance of early diagnosis and necessity of complete meticulous debridement on the extended case with multiple nerve palsies.