Title: When Ear Pain Is a Red Flag: Recognizing Necrotizing Otitis Externa
Episode Description:
What happens when a routine ear infection becomes a potentially life-threatening diagnosis?
In this episode of PEM CHATT, recorded at the AAENP conference in Nashville, we welcome Jill Ogg-Gress to discuss a memorable case of necrotizing otitis externa.
An older, immunocompromised patient initially diagnosed with otitis externa returned to the emergency department just three days later with worsening symptoms, hearing loss, and facial droop. What initially raised concern for stroke ultimately led to the diagnosis of necrotizing otitis externa with early osteomyelitis.
Jill shares the clinical clues that prompted further investigation, the importance of recognizing cranial nerve involvement, and why early imaging findings may not tell the whole story.
In This Episode:
- Recognizing red flags in patients with persistent or worsening otitis externa
- Why severe nocturnal ear pain deserves additional attention
- Hearing loss and facial nerve dysfunction as concerning neurologic findings
- The limitations of CT imaging in early disease
- When to escalate care, involve ENT, and consider advanced imaging
- Avoiding diagnostic anchoring when a patient's clinical course doesn't fit the initial diagnosis
Clinical Pearl:
A patient with otitis externa who develops disproportionate pain, hearing loss, or cranial nerve abnormalities needs reassessment for invasive infection. A CT without obvious bony erosion does not necessarily exclude early necrotizing otitis externa.
The Takeaway:
Sometimes the most important diagnostic skill is recognizing when the initial explanation no longer fits.
Listen to PEM CHATT for practical conversations and clinical insights from emergency medicine professionals.
Disclaimer: This podcast is intended for healthcare professional education and does not replace clinical judgment, institutional protocols, or specialist consultation.
