Uncommon disease with unusual presentation: A case report of acute necrotizing otitis media

INTRODUCTION: Acute necrotizing otitis media (ANOM) is defined as a severe middle ear infection that results in tympanic membrane necrosis. Commonly caused by bacteria infection. It is a rare entity of otitis media, with unknown prevalence. Usually seen in immunocompromised patients. CASE PRESENTATION: We present a case report of a 79-year-old diabetic male, who presented to the otolaryngology clinic with history of intermittent worsening nocturnal left ear pain. The clinical presentation was suggesting necrotizing otitis externa despite lacking the classical picture of external ear canal edema and granulation, in the presence of a dull bulging tympanic membrane. Then the patient developed hearing loss, along with ear discharge, high inflammatory markers, and significant imaging findings. This case represents an unusual presentation of ANOM. The patient responded well to aggressive medical treatment, along with grommet insertion. CONCLUSION: Despite the development of antibiotics, ANOM is still possible, especially in high-risk patient. A high index of suspicion, along with detailed history, physical examination, and supportive imaging are needed, to diagnose ANOM. Aggressive treatment with antibiotics should be started immediately, guided by the culture results, to improve the prognosis and prevent further complications.