Retropharyngeal Abscess with Neurological Presentation: Diagnostic Challenge in a Hearing-Impaired Patient

Abstract

Objective: The aim of this study is to present a case of retropharyngeal abscess in an elderly male patient with comorbidities of congenital hearing loss and uncontrolled diabetes mellitus, and to clinically evaluate the unusual neurological symptomatology with which this infection presented. Our study emphasizes the diagnostic challenges encountered in deep neck infections and the necessity of multidisciplinary evaluation, particularly in patient populations with sensory deficits.

Material and Methods: Our case involves a male patient approaching sixty years of age who presented to our clinic with cephalgia developing over approximately thirty days and a progressive pain syndrome that had intensified over the past five days. The patient's history was notable for paresthesia complaints in the right extremities. The patient's past medical history included congenital hearing deficit and a twenty-year history of type 2 diabetes mellitus. Clinical examination revealed vital parameters within normal limits, while biochemical analyses demonstrated elevated inflammatory markers (CRP: 21.6 mg/L, WBC: 12,700/μL). Advanced imaging modalities performed to exclude neurovascular pathologies revealed an abscess formation measuring 10×15×16 mm in the right retropharyngeal space. Otolaryngology consultation identified edema in supraglottic structures and restricted ipsilateral vocal cord mobility.

Discussion and Conclusion: The presented case demonstrates that the etiology of retropharyngeal abscess may deviate from conventional clinical presentation and can be masked by neurological symptoms. Diabetes mellitus plays a critical role in the progression of infectious processes due to immune system impairment and microvasculatory compromise. In patient populations with hearing impairment, communication barriers during history-taking and limitations in subjective symptom assessment increase the importance of objective diagnostic approaches. Contrast-enhanced computed tomography of the neck is considered the gold standard for retropharyngeal abscess diagnosis and is of vital importance in early diagnostic approaches. In conclusion, in patient populations with high comorbidity burden, maintaining a high clinical suspicion index and implementing comprehensive imaging protocols in the face of atypical presentations play a key role in reducing morbidity and mortality. This case emphasizes the importance of multidisciplinary approach and early intervention in achieving successful outcomes.