Facial Nerve Paralysis in Malignant Otitis Externa: Outcomes and Risk Factors

Introduction: Facial nerve paralysis is a feared complication of malignant otitis externa (MOE), indicating infection progression and severity. This study compares the characteristics and outcomes of patients with MOE and facial nerve paralysis to those without paralysis.

Methods: The National Inpatient Sample database (2012-2019) was queried for patients with a primary diagnosis of malignant otitis externa. Patients were categorized by presence or absence of facial nerve paralysis. Chi-squared and ANOVAs were performed using SPSS and R to compare demographics, comorbidities, and outcomes, with significance set at p<.05.

Results: 719 inpatient stays were included, with 80 patients experiencing facial paralysis. Those with facial paralysis were significantly older on average (71.9, S.D. 13.1) than patients without paralysis (55.5, S.D. 21.3, p<.001*). They had longer mean lengths of stay (7.71 days, S.D. 7.5) compared to those without it (4.9 days, S.D. 6.2, p<.001), but were not more likely to die during their stay (p=1.00). Patients with facial paralysis had higher rates of chronic blood loss anemia (2.5% vs 0.2%, p=.034), diabetes with (43.2% vs. 30.6%, p=.007) or without complications (53.8% vs. 38.2%, p=.007), and recent weight loss (10% vs. 3.4%, p=0.013). Patients with facial paralysis were less likely to be discharged routinely (47.5% vs. 70.1%, p< 0.001) but were more likely to require home healthcare (27.5% vs. 16.6%, p< 0.001) or be sent to another facility (23.8% vs. 8.6%, p< 0.001).

Conclusions: Patients with facial paralysis were significantly older, had longer lengths of stay, and exhibited higher rates of comorbidities, including diabetes, which is particularly concerning due to its association with nerve damage. Their distinct discharge patterns, including more frequent transfers to other facilities and home healthcare, reflect worse outcomes, indicating the need for additional post-discharge support. Despite longer stays, there was no significant difference in in-hospital mortality. These findings highlight the need for focused care during and after hospitalization for this higher-risk group.