Nandakumar Choorakkattukara Raman
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Thulaseedharan Sreedharan
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Ajayan Paithottiyil Varkey
BACKGROUND Malignant otitis externa (MOE) is a rare disorder occurring in elderly immunocompromised patients mainly in diabetics. Other immunocompromised conditions are myeloid malignancies, iatrogenic suppression secondary to treatment of malignancies, organ transplant patients, and HIV (Human Immunodeficiency Virus) patients. Most common causative organism is Pseudomonas aeruginosa. Staphylococcus aureus, Staphylococcus epidermidis also have been reported. Aspergillus species is the most common fungal pathogen causing this condition. METHODS This is a cross sectional study to find out the clinical profile of patients treated for MOE in the department of ENT of Government Medical College, Thrissur, Kerala. Sample size was 32. Patients were given a self-made questionnaire containing questions on age, gender, clinical history, and history of past illness. After getting the filled form, informed consent was taken. They then underwent general examination as well as ENT evaluation with emphasis on otological examination which included examination of ear and surrounding area. Swab from external auditory canal (EAC) was sent for culture and sensitivity. Granulations were taken from EAC to rule out malignancy. Antibiotics and antifungals depending on the pathogen were given for adequate duration. RESULTS Males were more commonly affected (78 %). Mean age of population is 60.97 ± 10.2 years. Diabetes mellitus was seen in 21 patients, of which 16 showed uncontrollable diabetes. Otalgia was present in all the patients. 14 patients showed ear discharge. Facial palsy was present in 8 patients only. Increased ESR was seen in all patients. Culture and sensitivity of all patients showed growth of Pseudomonas only. CT (Computed Tomography) revealed soft tissue in external auditory canal of all patients. At the end of the study, complete remission was seen in 18 patients. Follow up was done in 3 months and 6 months. Facial palsy was relieved in 50 % patients. CONCLUSIONS MOE predominantly affects elderly immunocompromised patients especially patients with uncontrollable diabetes. Most common organism isolated was Pseudomonas aeruginosa. Otalgia which felt more in night (nocturnal otalgia), otorrhoea, granulation in external auditory canal are the important parameters for the diagnosis of this condition. HRCT (High-Resolution Computed Tomography) temporal bone is used to see the extent of disease and also for diagnosis. ESR and CRP levels indicate the prognosis. Complete remission seen in most of the patients and facial palsy3 was relieved in 50 %. This study can be used to predict the disease progression, and to formulate a treatment plan so that morbidity and mortality associated with it can be avoided as much as possible. KEYWORDS Malignant Otitis Externa, Necrotising Otitis Externa, Pseudomonas aeruginosa, Nocturnal Otalgia, Immuno Compromised Condition
Atypical presentations of malignant otitis externa
