INTRODUCTION:One of the most common complications during endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP) is bleeding, which increases the time of surgery. A strategy for reducing intraoperative bleeding is the administration of preoperative corticosteroids and antibiotics. METHODS:We aimed to assess the degree and intensity of inflammation in CRSwNP histological specimens from patients who received immediate preoperative treatment with oral corticosteroids and antibiotics, compared with those who did not. The study group consisted of 50 patients who received preoperative corticosteroids and antibiotics, and the control group consisted of 50 patients who had not received any pretreatment. Immunohistochemical expression of periostin in nasal polyp tissue from each group was evaluated and compared to assess the prognostic value of this protein. RESULTS:There is a statistically significant difference between the control group and the study group in periostin expression (increased in the former) (p < 0.001). The pretreatment group has a significantly lower score (study group means H-score = 112.7 (standard deviation (SD) = 40.4)/control group mean H-score = 159.4 (SD = 42.3)). Moreover, a statistically significant positive correlation between periostin concentration and vascularity (microvessel density and optical density of the vascular endothelial marker) in the pretreatment group is not observed (rho = -0.02, p = 0.907; rho = 0.07, p = 0.713, respectively). CONCLUSIONS:The results support the preoperative administration of systemic corticosteroids and antibiotics to reduce the degree and intensity of inflammation in CRSwNP; this may impact the surgical field during ESS. Further cohort studies are needed to validate this recommendation.

Existing European national guidelines agree to provide cochlear implantation to children with bilateral severe to profound hearing loss and to offer bilateral treatment depending on the hearing status of the best hearing ear and progression of hearing loss, and in the case of congenital hearing loss to do this at the youngest possible age. However, studies and reports demonstrate substantial and persistent disparities in the provision of pediatric cochlear implantation across Europe. Variations in national policies, service quality, and access to timely diagnosis and intervention continue to affect equitable care, even in high-income countries. These findings underscore the need for a coordinated, European-level approach to harmonize clinical practice and guidance. A group of European experts, professionals and patient representatives have set out to develop consensus statements to address the disparity in European provision. The consensus statements have been drawn up by the group in an iterative process of online and in-person group discussions. The European consensus statements may also contribute to awareness of cochlear implantation for children and to ensure effective services for children with severe to profound hearing loss who are eligible for cochlear implantation.

UNLABELLED:Vestibular migraine (VM) is a common yet frequently underdiagnosed neurological condition, marked by recurrent episodes of vertigo and other vestibular symptoms in association with migraine features. It predominantly affects women aged 30-50 years and has an estimated prevalence of 1%-5% in the general population. This narrative review explores current knowledge surrounding VM, including its epidemiology, proposed mechanisms, diagnostic complexities, and treatment approaches. The pathophysiology remains incompletely understood but may involve dysfunction in vestibule-cerebellar pathways, ion channel abnormalities, and trigeminal system activation. Diagnosing VM is clinically driven, requiring careful evaluation of vestibular complaints alongside migraine-associated symptoms. Patients commonly report vertigo and headaches, while clinical assessment may uncover ocular motor disturbances, canal paresis, and balance issues. Supplementary tests such as ocular and cervical vestibular evoked myogenic potentials can aid in diagnosis, though they are not definitive. Differential diagnosis is essential due to symptom overlap with other vestibular disorders like Ménière's disease, episodic ataxia type 2, and benign paroxysmal positional vertigo. Treatment includes acute interventions with vestibular suppressants and triptans, vestibular rehabilitation programs, and preventive pharmacotherapy such as β-blockers, calcium channel blockers, and certain antidepressants. Despite these options, clinical evidence remains scarce, primarily relying on small-scale trials and expert consensus. No universally effective regimen has yet been identified. Overall, VM poses significant diagnostic and therapeutic challenges, underscoring the need for further research to clarify its mechanisms, improve diagnostic precision, and develop evidence-based treatment strategies that could lessen its burden and improve patient outcomes.

INTRODUCTION:Reliable assessment of both functional and aesthetic outcomes is essential in rhinoplasty. The Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) is widely used internationally, but no validated Greek version was previously available. The objective of this prospective comparative observational study is to translate, culturally adapt, and validate the SCHNOS for Greek-speaking patients. METHODS:The SCHNOS underwent forward-backward translation, expert review, and pilot testing. A total of 49 participants were included (24 rhinoplasty patients and 25 controls). Internal consistency (Cronbach's α), test-retest reliability (intraclass correlation coefficient (ICC)), and discriminant validity (Mann-Whitney U test) were assessed. RESULTS:Internal consistency was excellent (SCHNOS-O α = 0.90; SCHNOS-C α = 0.98). Test-retest reliability was also excellent (ICC = 0.990 and 0.995). Rhinoplasty patients scored significantly higher on both subscales than controls (P < 0.001), confirming discriminant validity. CONCLUSIONS:The Greek SCHNOS is a reliable and valid patient-reported measure for functional and aesthetic rhinoplasty outcomes.

BACKGROUND: Primary ciliary dyskinesia (PCD) is a rare genetic disorder that affects the respiratory and auditory systems. This study aims to assess the prevalence, type, and severity of bilateral hearing loss (HL) in PCD and Kartagener syndrome (KS) patients, examining age-related differences and chronic impacts of otologic pathologies. METHODS: A total of 19 patients (38 ears), including 6 children and 13 adults, were evaluated from June to September 2021. Comprehensive clinical examinations included otoscopy, tympanometry, and pure tone audiometry (PTA) for air and bone conduction. Tympanometry findings were compared with otoscopic results. Statistical analyses were conducted using SPSS v16.0 (SPSS Inc.; Chicago, IL, USA), with a significance threshold of P ≤ .05. RESULTS: Hearing loss was identified in 42.1% of patients, with conductive HL predominant in children (3 out of 4), while mixed HL was more common in adults (3 out of 4). Tympanometry results showed 57.9% type A and 42.1% type B findings, correlating with otoscopic observations. Chronic otitis media with effusion (OME) and tympanosclerosis (TS) were the primary pathologies contributing to middle ear damage. Age was significantly correlated with HL severity (P= .005). Mild HL was most common (62.5%), followed by moderate HL (25%) and moderately severe HL (12.5%). CONCLUSION: This study identifies distinct age-related patterns in the type and severity of HL among PCD patients, with sensorineural components observed in adults due to progressive middle ear damage. Audiological evaluations are essential for identifying these complications. Further research is needed to optimize treatment approaches and understand the progression of HL in PCD/KS patients.

Jugulotympanic paragangliomas (JTPs) are rare, benign, but locally aggressive neuroendocrine tumors of the temporal bone and jugular foramen. Due to their proximity to critical neurovascular structures, they can cause considerable morbidity. This study retrospectively assesses treatment outcomes in JTP patients, examining the effectiveness of surgical resection and stereotactic radiosurgery (RS) in tumor control and recurrence prevention. A retrospective analysis was performed on 11 adult patients diagnosed with JTP from January 2022 to December 2024. Data collected included demographics, tumor characteristics, surgical approach, histopathology, and follow-up imaging. Tumors were classified using the Fisch system, and the Ki-67 index was used to assess proliferative activity. Eleven patients (seven females and four males; median age = 64.5 years) were included. Tumor sizes ranged from 1.0 × 0.5 cm to 2.7 × 2.2 cm. Based on the Fisch classification, six tumors were class B, two were class A, one was class C1, and one was class D1. All patients underwent surgical excision via an endoaural-transcanal approach with potassium titanyl phosphate (KTP) laser hemostasis. Complete resection was achieved in five cases; six required additional stereotactic RS. Follow-up imaging showed no recurrence in fully resected cases, and tumor control in those treated with RS. Most tumors had a Ki-67 proliferation index < 5%. Surgical resection remains the preferred treatment for small, accessible JTPs. For most glomus jugulare cases, as well as residual or surgically complex tumors, a combination of surgery and RS plays a crucial role in effective management. The Ki-67 proliferation index does not independently predict recurrence.

Vestibular neuronitis (VN) is a prevalent peripheral vestibular disorder presenting with sudden unilateral vestibular loss, leading to acute vertigo without associated cochlear or neurological symptoms. Diagnosis remains challenging due to symptom overlap with other vestibular and central disorders. This study reviews the epidemiology, pathogenesis, and diagnostic approaches for VN to propose a streamlined, evidence-based diagnostic algorithm. A comprehensive literature review was conducted, analyzing 114 studies, including randomized controlled trials, systematic reviews, and clinical guidelines. Emphasis is placed on the clinical history and bedside examinations, supported by ancillary tests to confirm the diagnosis and differentiate VN from central and other peripheral causes of vertigo. The proposed algorithm aims to enhance diagnostic precision and support clinical decision-making.

To synthesize current knowledge on the utriculo-endolymphatic valve (UEV, Bast’s valve)—a flap-like structure at the junction of the utricular and endolymphatic ducts and to address the central question of whether it represents a passive anatomical remnant or an active regulator of endolymphatic homeostasis with implications for disorders such as Ménière’s disease. A critical narrative review of anatomical, imaging, experimental, computational, developmental, comparative, and pathological studies was conducted. Literature was identified through PubMed/MEDLINE, Embase, Web of Science, Scopus, and citation tracking. Sources included human temporal bone reconstructions, animal models, finite element simulations, hydrostatic measurements, and clinical reports examining associations between valve morphology and endolymphatic hydrops. The UEV is consistently identified across species and developmental stages, with asymmetric morphology favoring directional flow. Advanced imaging (micro-CT, SR-PCI) and reconstructions confirm its structural plasticity, while animal and computational models support a check-valve role in modulating endolymph exchange. Pathological observations implicate valve dysfunction in hydrops distribution in MD, though clinical correlations remain inconsistent. No in vivo studies have captured valve dynamics, and interindividual variability remains underexplored. The UEV is an evolutionarily conserved feature of the vestibular labyrinth, likely contributing to inner-ear hydrodynamics. Whether it functions as an active regulator or a passive remnant remains unresolved. Progress will depend on ultra–high-resolution imaging, computational modeling, and prospective clinical studies to clarify its role and potential value for diagnosing and managing hydrops-related disorders.

Malignant otitis externa (MOE) is a rare but serious condition primarily caused by Pseudomonas aeruginosa. Fungi, particularly in immunocompromised individuals, can also be a contributing factor. A systematic review was conducted, following PRISMA guidelines, to evaluate the literature on fungal malignant otitis externa (FMOE), focusing on its etiology, patient demographics, clinical presentation, and treatment. Out of 464 articles identified, 10 were analyzed in detail, involving 197 patients with a mean age of 65.9 years. Of the total patients, 143 were male (72.6%), 52 were female (26.4%), and the gender of the remaining two was not specified. One hundred and fifty-five patients (78.7%) had underlying immunosuppressive conditions such as diabetes mellitus, chronic kidney failure, corticosteroid use, chemotherapy, and AIDS. Fungal cultures were positive in 107 cases (54.3%), with Candida and Aspergillus species being present in nearly equal proportions. There were no significant differences between fungal and non-fungal MOE in terms of clinical presentation and diagnostic methods. Conservative treatment was used in 179 patients (90.8%), with 172 of them (87.3%) receiving antifungals. Itraconazole and voriconazole were the most common antifungals, while amphotericin B was less frequently used due to side effects. In some cases, antifungals were combined with antibiotics. Surgical interventions were performed in 35 patients (17.8%), and hyperbaric oxygen therapy was used in 34 of them (17.3%). Eight patients with FMOE died, and the mortality rate was 4%. Late diagnosis, cranial nerve involvement, and inadequate treatment may contribute to higher mortality. Given the potential underdiagnosis of FMOE, early incorporation of antifungal medications into empirical treatment protocols could improve outcomes for patients with a poor prognosis.

Introduction:This study aimed to investigate the relationship between preoperative fine needle aspiration cytology (FNAC) for parotid tumors and the level of surgical training among residents, as well as to further elucidate its effectiveness as a diagnostic tool in the hands of the treating physician. Materials and Methods:Surgical records from patients who underwent parotid surgery between 2014 and 2022 were retrieved. Residents reported their perceived level of training duringthese procedures. Contingency tables were used to correlate the cytological with final histopathological results. Results:A total of 286 patients who had undergone preoperative FNAC were included in the study. A preoperative diagnosis of pleomorphic adenoma or Wharthin's tumor was significantly associated with higher training scores among surgical residents. In contrast, a diagnosis of malignancy, other benign tumors, or indeterminate cytology was correlated with poor training scores (χ2 = 176.35; df = 2; p-value <0.001, Cramer's V 0.79). FNAC demonstrated a sensitivity of 88% and a specificity of 99.2% for detecting malignancy, with a positive likelihood ratio of 103.8 (95% CI: 26.02-414.34) and a negative likelihood ratio of 0.12 (95% CI: 0.06-0.26). Conclusions:Our findingssuggest that preoperative cytological diagnoses of parotid tumors with a favorable prognosis, such as Wharthin's tumors, can enhance training and mentorship opportunities provided by senior surgeons. This is particularly significant for academic institutions with residency programs.

Screen exposure has both negative and positive effects on the level of language skills a child acquires. The purpose of this review is to address current literature on the possible relationship between unsupervised screen exposure and language development in children and to provide recommendations to caregivers regarding screen exposure of children, taking into consideration the possible effects. A scoping review was conducted using the PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online) database. A total of 590 articles were retrieved and considered for inclusion. Twenty-one articles were finally included and reviewed with an emphasis on language, communication, and executive skills as well as cognitive development. The negative effects of screen exposure for children outweigh the positive effects. The largest number of studies demonstrate that unsupervised screen exposure may negatively impact a child's language usage and cognitive and executive skills, disrupt playtime, and affect the quality of sleep. On the other hand, supervised screen use is associated with improved language skills. More evidence is needed on unsupervised exposure in children to new types of screens. As technology could play a significant role in schools in the future, additional research is required to create educational media for schoolchildren with specific guidelines.

Screen exposure has both negative and positive effects on the level of language skills a child acquires. The purpose of this review is to address current literature on the possible relationship between unsupervised screen exposure and language development in children and to provide recommendations to caregivers regarding screen exposure of children, taking into consideration the possible effects. A scoping review was conducted using the PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online) database. A total of 590 articles were retrieved and considered for inclusion. Twenty-one articles were finally included and reviewed with an emphasis on language, communication, and executive skills as well as cognitive development. The negative effects of screen exposure for children outweigh the positive effects. The largest number of studies demonstrate that unsupervised screen exposure may negatively impact a child's language usage and cognitive and executive skills, disrupt playtime, and affect the quality of sleep. On the other hand, supervised screen use is associated with improved language skills. More evidence is needed on unsupervised exposure in children to new types of screens. As technology could play a significant role in schools in the future, additional research is required to create educational media for schoolchildren with specific guidelines.

Tumors located in the nasal cavity, paranasal sinuses and the skull base comprise a wide range of histologic subtypes. Among them, neuroendocrine and undifferentiated tumors are rare but noteworthy, because of their distinctive features, aggressive nature, and diagnostic complexities. A literature search was conducted in the PubMed/MEDLINE and the Scopus databases from 2019 until inception. The keywords "neuroendocrine", "undifferentiated", "nose", "sinonasal", "paranasal", "skull base" were used. Thirty-eight articles referring to neuroendocrine and undifferentiated tumors of the nose, paranasal sinuses and the skull base were finally included and analyzed. Neuroendocrine and undifferentiated tumors of the nose, paranasal sinuses and the skull base are infrequent malignancies, most commonly affecting middle-aged men. They usually present with non-specific symptoms, even though ocular or neurologic manifestations may occur. Prognosis is generally poor; however, novel targeted and immunological therapies have shown promising results. Sinonasal Neuroendocrine Carcinomas (SNECs) carry distinct histological and immunohistochemical features. Management consists of surgical resection coupled with systematic therapy. Sinonasal Undifferentiated Carcinomas (SNUCs) lack specific squamous or glandular features. They typically stain positive for pancytokeratin and INI1 antibody. Treatment includes induction chemotherapy, followed by a combination of chemotherapy and radiotherapy. Olfactory neuroblastomas (ONBs) have neuroepithelial or neuroblastic features. They show diffuse positivity for various markers, including synaptophysin, chromogranin, and neuron-specific enolase (NSE). Surgical resection plus radiotherapy is considered the treatment of choice. In conclusion, neuroendocrine and undifferentiated tumors arising from the nose, paranasal sinuses and the skull base represent a unique group of malignancies. A thorough understanding of their clinical features, molecular changes, diagnostic approaches, treatment modalities, and prognostic factors is critical for providing optimal patient care. Still, continued research efforts and multidisciplinary collaboration are warranted, in order to improve outcomes for patients diagnosed with these rare and aggressive tumors.

IntroductionDizziness and vertigo represent well-established symptoms of COVID-19. An overexpression of cytokines, a condition often described with the term "cytokine storm" or "hypercytokinemia", is a key characteristic of SARS-Cov-2 infection and plays a pivotal role in disease progression and prognosis. Among them, IL-6 is of major importance.PurposeThe purpose of this study is to investigate any probable IL-6 serum titer difference in COVID-19 patients with vertigo (V+) or without vertigo (V-) admitted to the COVID-19 internal medicine departments of Attikon University Hospital, Athens, Greece, within 12 months.MethodsThe sample consisted of 52 COVID-19 patients who were diagnosed between January 1, 2020, and December 31, 2020. Of those, 31 reported vertigos during their admission (V+), while the remaining 21 COVID-19 patients did not complain of such symptoms (V-). Results Higher IL-6 serum levels post-COVID-19 infections lead to higher incidence rates of vertigo symptoms (p<.005), regardless of gender and age (p.005).

Objective To review the epidemiology, pathogenesis, diagnosis, and treatment of unilateral vestibular weakness (UVW), and critically assess the related evidence.Methods Literature research in Medline and other database sources until August 2020.Results The total number of included studies was 39.Conclusion The lifetime prevalence of UVW in the general population is 0.2%; the respective incidence is unknown. UVW frequently overlaps with other diagnoses; nevertheless, there is usually a history of a single, preceding, monophasic event. The respective criteria include unsteadiness of more than two months, clinical exclusion of BPPV, and exclusion of Meniere's disease, central lesion, or bilateral vestibular dysfunction, and more than 25% inter-aural asymmetry in the caloric test. The latter represents the golden testing standard in suspected patients, and should be complemented with vestibulo-ocular reflex assessment via rotation-testing and video head-impulse test. Posturography can be useful to evaluate postural stability. Questionnaire-based assessments may assess symptom severity, the ensuing disability, and the subjective perception of patients' overall balance status. MRI is advised in vertiginous patients in the presence of neurologic signs and symptoms, risk factors for cerebrovascular disease, or progressive unilateral hearing loss. Vestibular rehabilitation is effective in patients with UVW, whilst pharmacological treatment is of limited value.

Introduction:Proteus syndrome (PS) is a rare genetic disorder usually caused by mutations in AKT1 or PTEN genes, characterized by multiple, asymmetric tissue overgrowth with high clinical variability. Sinonasal neuroendocrine carcinomas (SNEC) are exceptionally rare tumors encountered in the ethmoid sinus, nasal cavity, or maxillary sinus.Case Report:We report a 35-year-old patient with PS, who underwent successful surgical removal of a well-differentiated SNEC obstructing his nasal cavity and highlight the role of the otolaryngologist for safe airway management, minimal surgical intervention and coordination of the multidisciplinary care. Histologically, focally hyperplastic mucosal epithelium of respiratory type of the nasal chamber was noticed along with seromucinous glands and capillary congestion of the subepithelial fibrovascular tissue. The limited presence of neoplastic tissue with histomorphological and immunophenotypic features of a neuroendocrine neoplasm was focally observed. Tumor cells grow in the form of islets within a vascular stroma; these neoplastic cells are immunohistochemically positive for synaptophysin, CD56, EMA, Ki67 (low expression, cell proliferation rate: 2%), CD31, chromogranin and pancytokeratin AE1 / AE3 as well as for S-100 protein (weak intensity).Conclusions:This first description of a SNEC in a PS patient, might hint towards a common basis between the two conditions, due to the mosaic AKT1 variant and an activated AKT/PIK3CA/PTEN pathway.

The purpose of this study is to investigate the risk factors of intracranial complications in adult patients with Pott Puffy Tumor (PPT). A systematic review was conducted of clinical studies from January 1983 to December 2022 that reported on PPT adult patients. The full-text articles were reviewed for the patients' ages, sex, cultured organisms, surgical procedures, clinical sequalae, and underlying diseases that may affect the onset of intracranial complications in PPT adult patients. A total of 106 studies were included. Medical data were reviewed for 125 patients (94 males, 31 females). The median age was 45 years. A total of 52% had comorbidities, mostly head trauma (24.5%), sinus/neurosurgical operations (22.4%), immunosuppression conditions (13.3%), diabetes mellitus (9.1%), cocaine use (7.1%), or dental infections (6.1%). A total of 28 cultures revealed Streptococcus (22.4%), 24 contained staphylococci (19.2%), and 22 cultures contained other pathogens (17.6%). An amount of 30.4% developed intracranial complications, with the most common being epidural abscesses or empyemas (55.3%), as well as subdural (15.7%) and extradural lesions (13.2%). Age, DM, and immunosuppression conditions are significantly associated with intracranial complications (p < 0.001, p = 0.018 and p = 0.022, respectively). Streptococcus infection is associated with intracranial complications (p = 0.001), although Staphylococcus and other microorganisms are not. Surgical intervention, mainly ESS, and broad-spectrum antibiotics remain the cornerstones of treatment.

Feeding abnormalities, swallowing dysfunction, and gastrointestinal issues cause poor weight gain, oral motor dysfunction, and air swallowing in children with Rett syndrome (RTT). Pneumonia is the leading cause of death. Our study describes fiberoptic endoscopic swallowing findings in 11 female RTT children. Each patient was evaluated using the 8-point Penetration/Aspiration Scale (PAS). The average age was 7 years. All patients had tongue dyskinesis and prolonged oral stage. Eight girls exhibited liquid entering the airway without coughing, whereas 6 did well with pureed meal. Three girls had pneumonia. Age was not correlated with pneumonia episodes (P = .18). Pureed material was related with pneumonia (P = .006), whereas liquids were not. Pureed PAS was positively correlated with Liquid PAS (P = .008) and age (P = .004). All aspiration/penetration incidents occurred before the pharyngeal phase. No patient under 7 years experienced pneumonia episodes. Silent aspiration can occur early in infancy, although pneumonia episodes can occur later.

Otosclerosis, also known as otospongiosis, is a primary osteodystrophy of the otic capsule of the inner ear and one of the leading causes of deafness in adults. The rationale for medical therapy for otospongiosis is to slow down and eventually stop the phase of bone resorption. Conservative treatments include sodium fluoride (NaF), bisphosphonates, and other modern medicines. A systematic review of the existing and published articles and books until April 2021 has been conducted in Medscape, Google Scholar, PubMed, and other databases using appropriate terms. According to the results of the research, the administration of NaF for a period of at least six months stabilizes hearing thresholds (HTs), improves vestibular symptoms, and delays the worsening of tinnitus. The administration of bisphosphonates for a period of at least six months showed significant percentage differences in the improvement of hearing loss, dizziness, and tinnitus remission. In the already existing double-blind studies that were evaluated, groups of patients treated with bisphosphonates for at least 24 months showed greater stabilization of the mean air and bone conduction thresholds than groups of patients treated with a placebo. The new modern medications have not yet been widely administered clinically to draw useful conclusions, although the test results of some of their use are quite encouraging.

BACKGROUND:To investigate the differences in regard to the clinical, laboratory, and imaging findings as well as the treatment course between diabetic and non-diabetic, non-immunocompromised patients with malignant otitis externa. METHODS: A total of 36 hospitalized patients diagnosed with malignant otitis externa between January 2011 and December 2020 were divided into 2 groups according to their medical history, blood glucose, and glycated hemoglobin levels. RESULTS: Thirty-two patients were diabetic (group A) and 4 were non-diabetic, non-immunocompromised (group B). Otalgia was present in all patients (100%), followed by otorrhoea (67%) and edema (64%). Polyps were present in 18 patients (50%). Pseudomonas aeruginosa was isolated in 16 out of 25 positive cultures (64%). Four patients of group A and none of group B underwent surgery. Five patients of group A and none of group 13 had at least 1 cranial nerve involvement. The mean age was 77.22 +/- 8.17 for group A and 47.25 +/- 3.59 for group13(P <.001). No statistical significance was observed in regards to major symptoms, inflammatory markers (white blood cell, C-reactive protein, and erythrocyte sedimentation rate), positive imaging, and microbiological findings between the 2 groups. The average days of hospitalization were 42.41 +/- 31.06 for group A and 10.25 +/- 2.63 for group B (P <.049). Four diabetic patients died. CONCLUSION: Non-diabetic, non-immunocompromised adult patients with malignant otitis externa had a better response to antibiotic therapy and a shorter length of hospitalization. A high clinical suspicion for malignant otitis externa should always raise in cases of otitis externa that fail to respond in a topic and/or oral antibiotic treatment for more than a week.