MALIGNANT EXTERNAL OTITIS: THOUGHTS ABOUT RARE DISEASES AND REFERRAL IN PRIMARY HEALTH CARE

Introduction: Malignant external otitis (MEO) is an invasive and necrotizing infection that begins at the external acoustic meatus and quickly progresses to the parotid region, mastoid, facial nerve, middle ear, reaching the base of the cranium. Treatment usually lasts 4 to 5 weeks and, if not treated in time, can be fatal. It affects especially men over 60 and children with immunosuppressive disease, in tropical regions. Mortality rate is under 10%. Objective: Case report of MEO that shows a delay in referral from basic to the specialized care service, resulting in patient’s injury. Method: A case report and bibliographical review about MEO and criteria for referral to the SCS. Results and Conclusions: The report comes from Rio de Janeiro, Brazil, in 2010. The patient AVS, 73, male, entered the ENT Department of the Federal Hospital of Andaraí, complaining of facial paralysis and purulent discharge in the ipsilateral ear for the past 3 days. He had a history of 6 similar episodes that were treated in a health clinic as external otitis, using otological drops for 3 months. Soon after his admission, the patient was hospitalized and antibiotic therapy was initiated. After 5 months of treatment, the patient was discharged with the maintenance of facial paralysis, surgical excision of part of the mastoid, loss of hearing in his right ear and chronic vertigo/buzzing. All these conditions could have been avoided with early, appropriate intervention.