Hostname: page-component-77f85d65b8-5ngxj Total loading time: 0 Render date: 2026-04-12T15:44:09.336Z Has data issue: false hasContentIssue false
  • English
  • Français

Predictive factors for facial nerve palsy in malignant otitis externa: a TriNetX data analysis

Published online by Cambridge University Press:  06 January 2026

Huseyin Isildak Open the ORCID record for Huseyin Isildak [Opens in a new window]
Huseyin Isildak*
Affiliation:
Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA
*
Email: mdhuseyin@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Malignant otitis externa is a life-threatening infection in which facial nerve palsy is a morbid complication. This TriNetX study identified predictors of facial nerve palsy in malignant otitis externa.

Methods

Retrospective analysis compared malignant otitis externa-only (n = 12 032) versus malignant otitis externa plus facial nerve palsy (n = 719) cohorts for demographics, biochemical markers and co-morbidities using t-tests and odds ratios (p < 0.05).

Results

Male gender (p = 4.65 × 10−15) and Hispanic and/or Latino ethnicity (17.66 vs 13.02 per cent, p = 0.0014) predicted facial nerve palsy. The significant biochemical markers were albumin, blood urea nitrogen (p < 10−18), glucose, erythrocyte sedimentation rate (ESR), creatinine, iron and activated partial thromboplastin time. The key co-morbidities were hypertension (odds ratio = 3.72, p = 6.95 × 10−55), chronic kidney disease (odds ratio = 3.12, p = 1.44 × 10−49), malnutrition (odds ratio = 3.44) and electrolyte imbalances (odds ratio = 2.59). Migraines and/or headaches were non-significant.

Conclusion

Male sex, Hispanic and/or Latino ethnicity, hypoalbuminemia, elevated blood urea nitrogen and/or glucose and/or ESR, and co-morbidities (hypertension, chronic kidney disease, malnutrition) strongly predict facial nerve palsy in malignant otitis externa. Early risk factor management may prevent facial nerve palsy.

Keywords

external otitisfacial nerveepidemiologyinfectious diseases

Information

Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 140 , Issue 3 , March 2026 , pp. 252 - 257
Copyright
© The Author(s), 2026. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

Huseyin Isildak takes responsibility for the integrity of the content of the paper Presented as a poster at the Combined Otolaryngology Spring Meetings (COSM 2025) May 14-18, 2025, New Orleans, LA.

References

TriNetX, LLC. TriNetX Research Network. In: https://www.trinetx.com [30 April 2025]Google Scholar
Soudry, E, Hamzany, Y, Nageris, BI, Ben-David, J, Segal, S, Hilly, O. Malignant external otitis: analysis of severe cases. Otolaryngol Head Neck Surg 2011;144:758–62CrossRefGoogle ScholarPubMed
Loh, S, Loh, WS, Yuen, HW, Sun, J, Wang, DY, Tan, TY. Malignant otitis externa: an Asian perspective on treatment outcomes and prognostic factors. Otolaryngol Head Neck Surg 2013;148:991–6CrossRefGoogle ScholarPubMed
Klein, SL, Flanagan, KL. Sex differences in immune responses. Nat Rev Immunol 2016;16:626–38CrossRefGoogle ScholarPubMed
Trigunaite, A, Dimo, J, Jørgensen, TN. How does testosterone influence immune responses? Immunol Res 2015;62:279–86Google Scholar
Peled, C, Jotkowitz, A, Shvartzman, P. Diabetes in the practice of otolaryngology. Diabetes Metab Syndr 2019;13:714–8Google Scholar
Velasco-Mondragon, E, Jimenez, A, Palladino-Davis, AG, Davis, D, Escamilla-Cejudo, JA, Vargas-Rosales, A et al. Hispanic health in the USA: a scoping review of the literature. Public Health Rev 2016;37:31CrossRefGoogle Scholar
Morales, LS, Lara, M, Kington, RS, Valdez, RO, Escarce, JJ. Socioeconomic, cultural, and behavioral factors affecting Hispanic health outcomes. J Health Care Poor Underserved 2002;13:477–503CrossRefGoogle ScholarPubMed
Schneiderman, N, Llabre, M, Cowie, CC, Barnhart, J, Carnethon, M, Gallo, LC et al. Prevalence of diabetes among Hispanics/Latinos from diverse backgrounds: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Diabetes Care 2014;37:2233–9CrossRefGoogle ScholarPubMed
Chen, CN, Prakash, S, Nair, SC, Menon, K, Pillai, S, Thomas, R et al. Correlation between clinical prognostic markers glycated haemoglobin (HbA1c), ESR and CRP levels and the stage of disease in malignant otitis externa. Indian J Otolaryngol Head Neck Surg 2022;74(Suppl):4567–72Google Scholar
Don, BR, Kaysen, G. The effect of inflammation on serum albumin levels. Nephrol Dial Transplant 2003;18(Suppl):v17–20Google Scholar
Gatta, A, Verardo, A, Bolognesi, M. Hypoalbuminemia in acute illness: a marker of severity and a target for intervention. Curr Opin Clin Nutr Metab Care 2012;15:481–7Google Scholar
Hollis, A, Evans, K, Palmer, J, Singh, A, Rahman, A, Gormley, P. Malignant otitis externa: causes for various treatment responses. Indian J Otolaryngol Head Neck Surg 2020;72:246–50Google Scholar
Hoste, EA, Kellum, JA, Selby, NM, Zarbock, A, Palevsky, PM, Bagshaw, SM et al. Acute kidney injury in critically ill patients: epidemiology and outcomes. Nat Rev Nephrol 2018;14:261–74CrossRefGoogle ScholarPubMed
Chonchol, M, Berl, T. Chronic kidney disease and infection: mechanisms of increased susceptibility. Semin Nephrol 2006;26:413–18Google Scholar
Preiser, JC, Ichai, C, Orban, JC, Groeneveld, AB. Metabolic and nutritional consequences of severe infection. Curr Opin Crit Care 2011;17:162–7Google Scholar
Esaki, S, Yamano, K, Katsumi, S, Fukuda, S. Facial nerve palsy after reactivation of herpes simplex virus type 1 in diabetic mice. Laryngoscope 2015;125:E143–8CrossRefGoogle ScholarPubMed
Bedell, SE, Bush, BT. Erythrocyte sedimentation rate: from folklore to facts. Am J Med 1985;78:1001–9CrossRefGoogle ScholarPubMed
Weiss, G, Goodnough, LT. Anemia of chronic disease. N Engl J Med 2005;352:1011–23CrossRefGoogle ScholarPubMed
Ganz, T. Hepcidin and iron regulation in health and disease. Am J Hematol 2019;94:E150–4Google Scholar
Nemeth, E, Ganz, T. The role of iron in infection and immunity. Immunol Rev 2015;264:176–91Google Scholar
Kato, S, Chmielewski, M, Honda, H, Pecoits-Filho, R, Matsuo, S, Yuzawa, Y et al. Uremia and immune dysfunction: implications for infection susceptibility. Clin J Am Soc Nephrol 2008;3:1396–403Google Scholar
Liamis, G, Filippatos, TD, Elisaf, MS. Electrolyte disorders in acute illness: implications for neurological outcomes. Eur J Intern Med 2016;29:3–10Google Scholar
Friedman, DI. Headache and neurological disease: a practical approach. Continuum (Minneap Minn) 2018;24:1026–45Google Scholar
Rojoa, DM, Shaikh, N, Sood, S, Sandhu, G, Nunez, DA. Necrotising otitis externa – is a poor outcome predictable? Diagnosis-based scoring system in patients with skull base osteomyelitis. J Laryngol Otol 2022;136:707–12CrossRefGoogle Scholar
Strippoli, GF, Craig, M, Deeks, JJ, Schena, FP, Craig, JC. Renoprotective effects of angiotensin-converting enzyme inhibitors in chronic kidney disease. Lancet 2006;368:1444–53Google Scholar
Rivas, MA, Beaty, TH, Baurley, JW, Haiman, CA, Stram, DO, Henderson, BE et al. Genetic diversity in Hispanic/Latino populations: implications for disease susceptibility. Nat Genet 2011;43:816–24Google Scholar