An immunocompetent, non-diabetic man in his 90s presented to A&E with headache and sudden-onset left abducens nerve palsy. He was treated for recurrent left otitis externa six months previously, with a normal CT of the petrous bone at the time.Ear appearances were unremarkable, but CT petrous bones revealed extensive skull base osteomyelitis extending to the petrous apex. MRI skull base and nuclear medicine technetium-99m hexamethylpropyleneamine-oxime white cell scanning confirmed active osteomyelitis.Necrotising otitis externa (NOE) is a complication of otitis externa and is more common in the elderly and immunosuppressed. Facial nerve palsies can occur due to anatomical proximity but there are only two other reported cases of isolated abducens nerve palsy associated with NOE. This case highlights the importance of fully treating otitis externa and the complexities of managing NOE in elderly and frail patients. It also illustrates the use of different imaging modalities to differentiate active and historic osteomyelitis.

Introduction Benign osteonecrosis (BON) of the external auditory canal (EAC) is a rare and under recognised otological condition characterised by localised bony necrosis of the tympanic plate. It represents a diagnostic challenge due to its clinical overlap with necrotising otitis externa (NOE), EAC malignancy, keratosis obturans, and other external ear pathologies. Risk factors include antiresorptive pharmacotherapy, particularly bisphosphonates and denosumab, hearing aid use, local mechanical trauma, haemodialysis, and smoking. This retrospective case series aims to characterise the clinical presentation, investigative findings, management strategies, and outcomes of patients diagnosed with BON at a single UK ENT centre. Methods A retrospective review was conducted of seven patients diagnosed with BON of the EAC at the ENT Outpatient Clinics, Tameside General Hospital, between January 2023 and December 2025. Inclusion criteria required a confirmed diagnosis based on clinical examination, histopathological biopsy, microbiological culture, and high-resolution computed tomography (HRCT) of the temporal bones. Data on patient demographics, presenting symptoms, risk factors, investigations, management, and follow-up outcomes were collected and analysed. Results Seven patients (four male, three female; median age 67 years, range 55-80) were included. None had diabetes mellitus. Three patients (43%) had received bisphosphonate therapy for three to five years. Three patients used hearing aids. One patient had chronic kidney disease requiring haemodialysis, and one presented with bilateral disease. All patients underwent HRCT temporal bone imaging and histopathological biopsy. Biopsy confirmed chronic inflammation and bony sequestrum without malignancy or features of NOE in all cases. All seven patients were managed conservatively with serial aural debridement and topical antimicrobial therapy. Progressive epithelialisation was achieved in all patients over a follow-up period of three to eight months. No patient required surgical intervention or hyperbaric oxygen therapy. Conclusions BON of the EAC is an underreported condition that can be successfully managed conservatively in the majority of cases. Clinician awareness is essential, particularly in patients receiving antiresorptive agents or using hearing aids. Exclusion of malignancy and NOE through biopsy and HRCT imaging is mandatory. Further prospective research is required to establish standardised diagnostic criteria and management guidelines.

Necrotizing otitis externa (NOE) represents a severe progression of otitis externa, particularly threatening in diabetic patients, with limited clinico-microbiological data for Indians. Therefore, it is of interest to evaluate the clinico-microbiological profile in 60 diabetic adults diagnosed with NOE at a tertiary center. Among participants (mean age 60.51±9.6 years; 60% male), universal findings included external auditory canal edema, otorrhea and severe nocturnal otalgia; pus cultures grew Pseudomonas spp. in 43.3% (n=26), with no growth in 13.3% (n=8), mild conductive hearing loss in 16.7% (n=10) and facial nerve palsy (with/without glossopharyngeal involvement) in 6.7% (n=4). Pseudomonas dominance and characteristic symptoms align with global patterns, but high complication rates underscore local management gaps. Thus, we report the Indian cohort profile of NOE in diabetes, informing targeted antibiotic strategies and early cranial nerve monitoring.

Purpose: The aim of this study was to investigate the safety and efficacy, as well as relief of symptoms after regular use, of 0.5% lidocaine hydrochloride solution in anhydrous glycerol (Auridol) in the form of ear drops, in patients with symptoms of otitis externa (OE) in a real-world setting. Methods: This real-world pre-post study included 64 subjects aged 1 to 69 years with symptoms as follow: swelling, pain due to regular exposure to water or caused by frequent use of detergents, pain due to prolonged wearing of earphones, or earwax clogging the external auditory canal. In each subject, following an otoscopic examination and interview given by an ENT, the Auridol treatment was initiated. The product was administered as two drops into the affected ear up to three times daily in patients with symptoms of OE. During each visit, physical and functional symptom were evaluated. In addition, the efficacy of using the product was assessment using a VAS scale. At the end of the study, subjects rated the product according to a Likert scale. Results: A statistically significant reduction in perceived pain was observed at t = 30' as well as t = 3 days after application. For physical symptoms assessed by an ENT, a statistically significant difference was observed between consecutive scores for two of the assessed parameters (redness and swelling.) The product was rated very highly by the subjects. Conclusions: The results suggest that a combination of anhydrous glycerol and 0.5% of lidocaine in the form of ear drops has a positive effect in the treatment of symptoms of OE.

Medicinal plants are widely used worldwide for ear, nose, and throat (ENT) disorders and have a long history of traditional application. This review aims to summarize current experimental and clinical evidence on medicinal plants used for ENT conditions such as otitis externa/media, tinnitus, vertigo, allergic rhinitis, pharyngitis, and laryngitis, and to support the identification of new plant species with antimicrobial potential against ENT pathogens. This review thoroughly summarizes recent developments from 2020 to 2025 and was conducted using electronic databases, including PubMed, Web of Science, Scopus, ScienceDirect, and Google Scholar, with predefined ENT and medicinal plants-related keywords. Frequently used species include Lavandula angustifolia, Thymus vulgaris, Curcuma longa, Zingiber officinale, Origanum vulgare, Glycyrrhiza glabra, Mentha piperita, Matricaria chamomilla, and Syzygium aromaticum, many of which show In vitro antibacterial, antifungal, or antiviral activity relevant to upper airway and oral/ENT infections. Evidence indicates that selected medicinal plants and their extracts or essential oils inhibit key ENT-related pathogens, including multidrug-resistant respiratory and pharyngeal bacteria. The compiled data, structured in comparative tables, highlight promising taxa and preparation types, and underscore gaps in clinical validation, standardization, and safety assessment. Overall, this review provides an evidence-based overview of ENT-related phytotherapy and a framework for future pharmacological and phytochemical studies aimed at developing novel plant-derived antimicrobials for ear, nose, and throat diseases.

Langerhans cell histiocytosis (LCH) is a rare, life-threatening condition that predominantly affects children. It is a diagnostically challenging condition due to several different clinical presentations. Presentations of LCH with otological involvement are considered rare. We report a case where LCH presented a six-month-old boy to our tertiary teaching hospital. The patient presented with a unilateral left postauricular soft tissue mass, with an associated left external ear canal lesion and middle ear effusion, which initially had the working diagnosis of mastoiditis. However, further imaging and molecular testing concluded the final diagnosis as LCH with multisystem involvement. When LCH does have otological involvement, it commonly involves the external and the middle ear, which can often be confused with otitis media and otitis externa. This case report highlights that misdiagnosis of LCH can occur due to its broad presentation. The case report also raises the importance that in cases of unilateral postauricular soft tissue masses with destructive findings on cross-sectional imaging and systemic symptoms and signs, LCH must be a differential diagnosis, and biopsy should be considered.