(0903) A Multinational Database Analysis of the Morbidity and Mortality of Malignant Otitis Externa

Introduction: Rates of complications and death due to malignant otitis externa (MOE) have not been thoroughly examined in large multinational cohorts. This study leverages a global research database to examine risk of complications from MOE based on risk factors of underlying diabetes mellitus (DM) and facial paralysis at presentation.

Methods: The TriNetX Research Network, with data from 2006-2023 across 83 healthcare organizations, was queried using ICD-10 codes to identify adults with a diagnosis of MOE, who were split into cohorts with and without DM, and with and without facial paralysis. Cohorts were examined for outcomes of all-cause mortality, osteomyelitis, cranial nerve (CN) palsies, meningitis, treatment with antimicrobial drugs, and surgical intervention within 12 months after MOE diagnosis. Absolute and relative risks were calculated after 1:1 propensity score matching for age and sex using the analytics tool within TriNetX.

Results: Of 9,704 adults with MOE (mean age at diagnosis 51 ± 20 years), 2,532 had preexisting DM (26%), 442 developed facial weakness (4.5%), and 357 died within 12 months (3.7%). The cohort with DM had higher 12-month risk than the cohort without DM of mortality (RR 2.17, 95% CI 1.68-2.81), osteomyelitis (RR 3.09, 2.61-3.67), meningitis (RR 2.43, 95% CI 1.31-4.52), facial nerve palsy (RR 2.65, 95% CI 2.09-3.37), other CN palsies (RR 2.32, 95% CI 1.53-3.53), and treatment with antipseudomonal drugs (RR 1.1, 95% CI 1.06-1.13), antifungals (RR 2.06, 95% CI 1.38-3.07), and surgery (RR 1.95, 95% CI 1.44-2.65). Subjects who developed facial nerve palsy after MOE, compared with those who did not, had a higher 12-month risk of mortality (RR 2.84, 95% CI 1.84-4.39), osteomyelitis (RR 3.17, 95% CI 2.41-4.17), other CN palsies (RR 5.21, 95% CI 2.69-10.12), and treatment with antipseudomonal drugs (RR 1.14, 95% CI 1.06-1.23), antifungals (RR 3.7, 95% CI 1.86-7.34), and surgery (RR 5.35, 95% CI 3.24-8.83).

Conclusions: Patients with DM and those who developed facial paralysis from MOE faced a significantly higher 12-month risk of complications and mortality than patients without these characteristics.