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

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 <i>Pseudomonas aeruginosa</i>, 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.