Necrotizing external otitis in children: report of two cases and review of the literature.

Necrotizing external otitis is described almost exclusively in elderly diabetics. A review of the literature revealed 12 children, ages 2 months to 21 years, who have been described with this problem. Two additional patients are reported here. In children the male:female ratio is 1:1, whereas in adults a 2:1 male preponderance is seen. Diabetes mellitus, present in 94.7% of adults, is seen in only 21% of children. Facial nerve paralysis occurs in 35% of the children as compared to 52% of the adults. Facial paralysis was permanent in 100% of the children, but only 36.3% of the surviving adults had permanent facial paralysis. Surgical intervention had no significant effect on either group. Other pediatric complications include external auditory canal stenosis (29%), auricular cartilage deformity (11%), and sensorineural hearing loss (18%). A 40% to 50% mortality rate is seen in adults whereas no deaths have been reported in children. The clinical presentation of necrotizing external otitis in children shares some features with the disease as described in adults. However, notable differences do exist and form the basis of this report. The proposed pathophysiology of necrotizing external otitis in adults and its significance for disease in children are also discussed.