Differential Diagnosis for Patient with Dysphagia, FN Paralysis, and CN 12 Palsy
- Single most likely diagnosis:
- Necrotizing External Otitis (NEC): Given the patient's symptoms of dysphagia, facial nerve (FN) paralysis, and cranial nerve (CN) 12 palsy, along with the lack of improvement on 2 weeks of intravenous antibiotics, NEC is a strong consideration. This condition is known for its aggressive nature and potential to cause significant neurological deficits, especially in diabetic or immunocompromised patients.
- Other Likely diagnoses:
- Petrous Apex Cholesteatoma or Petrous Bone Osteomyelitis: These conditions can lead to similar neurological deficits due to their location and potential for spreading infection. However, they might not as commonly present with the combination of dysphagia, FN paralysis, and CN 12 palsy without other significant symptoms.
- Skull Base Osteomyelitis: This condition can mimic NEC in its presentation and complications, including cranial nerve palsies. It's a consideration, especially if the patient has risk factors for osteomyelitis.
- Do Not Miss diagnoses:
- Malignant Otitis Externa with Intracranial Complications: Although NEC is a form of malignant otitis externa, emphasizing the potential for intracranial complications (e.g., brain abscess, meningitis) is crucial. These conditions are life-threatening and require immediate intervention.
- Cavernous Sinus Thrombosis: This is a rare but potentially fatal complication of facial or sinus infections. It can present with cranial nerve palsies and requires prompt anticoagulation and antibiotic therapy.
- Rare diagnoses:
- Sarcoidosis or Other Granulomatous Diseases: These can cause cranial nerve palsies, including FN and CN 12, but would be less likely given the acute presentation and the specific combination of symptoms.
- Tuberculous Otitis Media: Although rare, tuberculosis can affect the middle ear and cause neurological deficits. It's a consideration in patients from endemic areas or with a history of tuberculosis exposure.