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

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.