Clinical Profile of Patients with Malignant Otitis Externa in a Tertiary Care Centre

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

Download Full-text

Computed tomography of malignant otitis externa (In German)

Clinical Imaging ◽

10.1016/0899-7071(92)90106-j ◽

1992 ◽

Vol 16 (1) ◽

pp. 66

Keyword(s):

Computed Tomography ◽

Otitis Externa ◽

Malignant Otitis Externa

Download Full-text

Atypical presentations of malignant otitis externa

The Journal of Laryngology & Otology ◽

10.1017/s0022215110000307 ◽

2010 ◽

Vol 124 (11) ◽

pp. 1205-1208 ◽

Cited By ~ 7

Author(s):

Z Vourexakis ◽

M-I Kos ◽

J-P Guyot

Keyword(s):

Pseudomonas Aeruginosa ◽

Skull Base ◽

Diagnostic Criteria ◽

Otitis Externa ◽

Case Reports ◽

Clinical Manifestations ◽

Diabetic Patients ◽

Malignant Otitis Externa ◽

Life Threatening ◽

Atypical Presentations

AbstractIntroduction:Malignant otitis externa is a life-threatening infection of the skull base. Its presentation is not always typical.Case reports:We report three cases of malignant otitis externa which illustrate the diversity of its clinical manifestations and the difficulties in its diagnosis.Discussion:The perception of malignant otitis externa as an infection caused by Pseudomonas aeruginosa in diabetic patients is not always correct. The adoption of diagnostic criteria could be helpful in identifying atypical cases.

Download Full-text

Resistance of Pseudomonas to ciprofloxacin: implications for the treatment of malignant otitis externa

The Journal of Laryngology & Otology ◽

10.1017/s0022215106002775 ◽

2006 ◽

Vol 121 (2) ◽

pp. 118-123 ◽

Cited By ~ 31

Author(s):

J M Bernstein ◽

N J Holland ◽

G C Porter ◽

A R Maw

Keyword(s):

Pseudomonas Aeruginosa ◽

Otitis Externa ◽

White Cell Count ◽

Antibiotic Sensitivity ◽

Response To Treatment ◽

Reactive Protein ◽

Intravenous Antibiotics ◽

Cranial Nerve Palsies ◽

Malignant Otitis Externa ◽

Oral Ciprofloxacin

For fifteen years oral ciprofloxacin has been the standard treatment for malignant otitis externa, a sometimes fatal osteomyelitis of the skull base usually caused by Pseudomonas aeruginosa. Resistance to ciprofloxacin is developing. Over a 16-month period, we saw five cases where malignant otitis externa progressed, with the development of cranial nerve palsies in four cases, despite oral ciprofloxacin. Prolonged intravenous antibiotic therapy became necessary. One case was managed largely as an out-patient, but four patients spent many weeks in hospital. Only two cases had diabetes and this was monitored and controlled. Pseudomonas aeruginosa was isolated in four of the five cases, but antibiotic sensitivity to ciprofloxacin was not determined. In one case a later isolate was tested and found to be ciprofloxacin resistant. Progress was monitored by serial C-reactive protein (CRP) and white cell count. For diagnosis and assessing response to treatment we considered serial magnetic resonance imaging or computed tomography more useful than isotope bone scan. There must be a readiness to use intravenous antibiotics, as a response to ciprofloxacin can no longer be assumed. Bacterial isolates must be tested for sensitivity to antibiotics including ciprofloxacin, and further biopsy and culture are essential if treatment fails.

Download Full-text

Malignant otitis externa: case series

The Journal of Laryngology & Otology ◽

10.1017/s0022215110000691 ◽

2010 ◽

Vol 124 (8) ◽

pp. 846-851 ◽

Cited By ~ 32

Author(s):

T Ali ◽

K Meade ◽

S Anari ◽

M R ElBadawey ◽

I Zammit-Maempel

Keyword(s):

Pseudomonas Aeruginosa ◽

Cranial Nerve ◽

Cranial Nerve Palsy ◽

Otitis Externa ◽

Nerve Palsy ◽

Case Series ◽

Case Review ◽

Retrospective Case ◽

North East ◽

Malignant Otitis Externa

AbstractBackground:In the light of current concerns regarding ciprofloxacin resistance and the changing face of malignant otitis externa, we reviewed cases of malignant otitis externa treated in our centre, in order both to evaluate the current epidemiology of the condition and to assess the status of drug resistance in our patient population.Method:Retrospective case review of all malignant otitis externa cases managed in a tertiary referral centre in the north-east of England between 2000 and 2009.Results:Forty-one patients were identified, but the required data were available for only 37 cases. Patients' ages ranged from 51 to 101 years (median, 81 years). Diabetes was present in 51 per cent of patients (19/37), facial nerve palsy in 40 per cent (15/37) and multiple cranial nerve palsy in 24 per cent (9/37). Pseudomonas aeruginosa was the most commonly isolated organism (54 per cent), sensitive to ciprofloxacin in all cases.Conclusions:The incidence of cranial nerve palsy in our study was higher than in previous reports. The incidence of diabetes and Pseudomonas aeruginosa in our cohort was much lower than previously reported. The Pseudomonas aeruginosa strains isolated were all sensitive to ciprofloxacin, despite recent reports on emerging resistance.

Download Full-text

Synchronous Malignant Otitis Externa and Squamous Cell Carcinoma of the External Auditory Canal

Case Reports in Otolaryngology ◽

10.1155/2013/837169 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4

Author(s):

R. Y. Chin ◽

T. B. V. Nguyen

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

External Auditory Canal ◽

Otitis Externa ◽

Concomitant Treatment ◽

The Third ◽

Intravenous Antibiotics ◽

Malignant Otitis Externa ◽

Synchronous Tumour

Objectives. To discuss the management of a squamous cell carcinoma in the presence of malignant otitis externa.Study Design. We present only the third reported case in the literature of a synchronous tumour with malignant otitis externa in the literature.Methods. A case report and review of malignant otitis externa and squamous cell carcinomas of the external auditory canal are discussed.Results. A 66-year-old female is presented here with a 2-month history of a painful, discharging left ear refractory to standard antibiotic therapy. Computerised tomography, magnetic resonance imaging, technetium 99 m, and gallium citrate Ga67 scans were consistent with malignant otitis externa. Biopsy in the operating theatre revealed a synchronous squamous cell carcinoma of the external auditory canal. Primary resection of the tumour and surrounding tissues was performed with concomitant treatment with intravenous antibiotics.Conclusions. This is only the third case to be reported in the literature and highlights several important diagnostic and management issues of these two rare conditions. Both conditions may present in a similar manner on clinical assessment and radiological investigations. Aggressive management with surgical resection and treatment with appropriate intravenous antibiotics is necessary to give the best chance for cure.

Download Full-text

Management of malignant (necrotising) otitis externa

The Journal of Laryngology & Otology ◽

10.1017/s0022215110002550 ◽

2011 ◽

Vol 125 (12) ◽

pp. 1212-1217 ◽

Cited By ~ 21

Author(s):

S Hollis ◽

K Evans

Keyword(s):

Pseudomonas Aeruginosa ◽

Diagnostic Criteria ◽

Otitis Externa ◽

Causative Organism ◽

Current Opinion ◽

Resistance To Antibiotics ◽

Common Diagnosis ◽

Malignant Otitis Externa

AbstractAlthough malignant (necrotising) otitis externa is not a common diagnosis, there have been a number of recently reported cases with pathogens other thanPseudomonas aeruginosaas the causative organism. In addition, there are many published reports of resistance to antibiotics in cases of malignant otitis externa caused byPseudomonas aeruginosa. This review aims to assess the cases reported and to clarify the current opinion on the diagnostic criteria and management of such cases.

Download Full-text

Surgical Treatment of Malignant Otitis Externa MOE A New Hope Although Challenging

Otolaryngology Open Access Journal ◽

10.23880/ooaj-16000218 ◽

2021 ◽

Vol 6 (2) ◽

Author(s):

Akhil Chandra Biswas

Keyword(s):

Diabetes Mellitus ◽

Facial Nerve ◽

Surgical Management ◽

Sedimentation Rate ◽

Otitis Externa ◽

Adequate Dose ◽

Erythrocyte Sedimentation ◽

Malignant Otitis Externa ◽

Culture And Sensitivity ◽

Serious Disease

Objective: Malignant external otitis is an aggressive inflammatory condition of the external auditory canal. Most often affects elderly patients with diabetes mellitus. This is a serious disease which spreads in the skull base associated with cranial nerve complications and high morbidity-mortality rate. Malignant otitis externa requires urgent diagnosis and treatment. The primary and most effective treatment is to control the diabetes and to fight infection with the proper antibiotic in adequate dose and duration. If medical treatment fails aggressive surgical management is the only option to save life. We present a short experience in the management of this disease. The aim of this study was to present our experience with the surgical management of malignant otitis externa. Methods: All patients' records with malignant otitis externa during the last 5 years (2007-2012) were retrieved and reviewed. Diabetes mellitus profile, erythrocyte sedimentation rate, ear swab for culture and sensitivity, computed tomography, were investigated for all patients. Results: During the last 5 years (2014-2019), 5 patients with the diagnosis of malignant otitis externa were admitted to our hospital for investigation and treatment. All between 60 and 70 years of age, with severe persistent otalgia, purulent otorrhea, granulation tissue in the external auditory canal, and diffuse external otitis, and there were 2 patients with facial nerve palsy. Patients were confirmed to have diabetes. Ear swabs for culture and sensitivity usually revealed Pseudomonas aeruginosa. One patient by systemic antibiotic and two patients were treated by Local debridement and systemic antibiotics were sufficient to control the disease. Two patients were treated by aggressive surgical debridement (skull base debridement) with 360degree Facial nerve decompression. Patients were recovered from dreadful necrotizing infection but with facial paralysis. Conclusion: Malignant otitis externa is still a serious disease associated with cranial nerve complications and high morbiditymortality rate. The primary and most effective treatment is to control the diabetes and to fight infection with the proper antibiotic in adequate dose and duration, debridement of necrotic tissue, and sometimes aggressive surgical management. Monitoring of therapy response is done through normalization of erythrocyte sedimentation rate, control of diabetes mellitus.

Download Full-text