A Study on 7 Cases of Malignant External Otitis

Purpose: The progression of the otitic infectious process toward diseases of particular severity is often unpredictable, just as it is challenging to manage the patient over time, even after the apparent resolution of the disease. We aim to define a radiological reading key that allows us to correctly and promptly treat the disease, avoiding the possible severe complications. Methods: We conducted a retrospective study of 13 cases of basal cranial osteomyelitis (SBO) due to malignant external otitis, by the ENT Department of the University of Catania. Through a standardized approach and following the latest guidelines, we have evaluated all patients performing a standardized and personalized radiological protocol according to the stage of the patient’s pathology and modulating the treatment consequently. Results: Clinical signs have been observed such as otorrhea (100%), otalgia in 13/13 patients (100%), granulations in external auditory canal (100%), preauricular cellulitis in 9/13 patients (69%) headache 6/13 cases (46%), dysphonia 4/13 cases (31%). HRCT of the temporal bone proved useful in identifying even minimal bone lesions in 13/13 (100%) while improving MRI in vascular and nervous involvement, although in 1/13 patient with nerve palsy clinical symptomatology preceded radiological evidence. The 99mTc 3-phase planar bone scintigraphy was positive for SBO in 9/13 cases (69%) during the initial phase and, in 100% of the cases in images delayed to 2-3 hours. Subsequent checks up to 1 year, using the Ga 67 scintigraphy, excluded the presence of recurrences in 100% of patients. Conclusion: The osteomyelitis of the base of the skull is a severe complication of malignant external otitis, often not always easily diagnosed. Recurrence can occur up to 1 year after stopping therapy. Imaging techniques such as Tc and MRI are relevant for the initial diagnostic approach and the staging of the pathology and its complications. Nuclear medicine imaging plays a fundamental role in the evaluation of related osteoblastic activity, especially in the remission phase of the disease.

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Cranial Nerve Involvement in Malignant External Otitis: Implications for Clinical Outcome

Yearbook of Otolaryngology-Head and Neck Surgery ◽

10.1016/s1041-892x(08)79196-0 ◽

2008 ◽

Vol 2008 ◽

pp. 28-29

Author(s):

B.J. Balough

Keyword(s):

Clinical Outcome ◽

Cranial Nerve ◽

External Otitis ◽

Cranial Nerve Involvement ◽

Malignant External Otitis ◽

Nerve Involvement

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Malignant External Otitis: Review and Personal Experience

Acta Oto-Laryngologica ◽

10.3109/00016489609137954x ◽

1996 ◽

Vol 116 (sup521) ◽

pp. 3-16 ◽

Cited By ~ 37

Author(s):

Luca Amorosa ◽

Giovanni Carlo Modugno ◽

Antonio Pirodda

Keyword(s):

Personal Experience ◽

External Otitis ◽

Malignant External Otitis

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Bing-Neel syndrome or malignant external otitis in waldenstrom's macroglobulinaemia?

The Journal of Laryngology & Otology ◽

10.1017/s0022215100127197 ◽

1994 ◽

Vol 108 (6) ◽

pp. 492-493 ◽

Cited By ~ 1

Author(s):

W. C. Lee ◽

J. F. Sharp

Keyword(s):

Diabetes Mellitus ◽

Insulin Dependent Diabetes Mellitus ◽

Insulin Dependent Diabetes ◽

External Otitis ◽

Dependent Diabetes Mellitus ◽

Unique Case ◽

Malignant External Otitis ◽

Insulin Dependent ◽

Waldenstrom’S Macroglobulinaemia

AbstractMalignant external otitis is classically associated with insulin-dependent diabetes mellitus probably due to generalized systemic immunodeficiency (Mowet and Baum, 1971). A unique case of malignant external otitis associated with Waldenstrom's macroglobulinaemia is presented.

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Histopathology of the soft parts in 50 patients with malignant external otitis

The Journal of Laryngology & Otology ◽

10.1017/s0022215100108977 ◽

1989 ◽

Vol 103 (4) ◽

pp. 366-368 ◽

Cited By ~ 21

Author(s):

J. Bernheim ◽

J. Sade

Keyword(s):

Skin Lesions ◽

External Otitis ◽

Pathological Feature ◽

External Ear ◽

Ear Canal ◽

Malignant External Otitis ◽

External Ear Canal ◽

External Canal ◽

Skin Biopsies ◽

Skin Coverage

AbstractReports concerning the lesions of the skin coverage of the external ear canal in malignant external otitis (M.E.O.) are very few. To evaluate this problem, we studied the skin lesions of 45 skin biopsies from 40 M.E.O. patients, 23 from regions covering the osseous part of the ear structure, seven from the cartilaginous part of the external canal and 15 from both parts. The epidermis was normal in nine, thickened in 16, with acanthotic thickening and pseudoepitheliomatous hyperplasia in 20. In the dermis the amount of collagen was normal, but it was infiltrated by the inflammatory process. Acute inflammation was observed in 16 biopsies, subacute in 23, chronic in six. A mixture of acute and chronic changes was present in 18 biopsies. No major abnormalities of the vasculature could be detected. The distinguishing pathological feature of M.E.O. concerns the typical topographic distribution of the inflammation in the osseous part of the external ear canal.

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Student Research Award 1993: Characteristics of Cerumen in Diabetic Patients: A Key to Understanding Malignant External Otitis?

Otolaryngology ◽

10.1177/019459989310900407 ◽

1993 ◽

Vol 109 (4) ◽

pp. 676-679 ◽

Cited By ~ 30

Author(s):

Peter V. Driscoll ◽

Anand Ramachandrula ◽

Dean A. Drezner ◽

Tracy A. Hicks ◽

Scott R. Schaffer

Keyword(s):

Diabetes Mellitus ◽

External Otitis ◽

Diabetic Patients ◽

Immunocompromised Patients ◽

Student Research ◽

Fatal Disease ◽

Malignant External Otitis ◽

Research Award ◽

Patients With Diabetes

Malignant externa otitis is a potentially fatal disease in diabetic and other immunocompromised patients. Cerumen contains defense properties that protect the patient against infection. We tested the hypothesis that patients with diabetes mellitus have abnormalities in their cerumen that affect the environment of their external auditory canals and may predispose them to malignant externa otitis.

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Malignant External Otitis: Further Considerations

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348947708600401 ◽

1977 ◽

Vol 86 (4) ◽

pp. 417-428 ◽

Cited By ~ 58

Author(s):

James R. Chandler

Keyword(s):

External Auditory Canal ◽

Soft Tissues ◽

Sinus Thrombosis ◽

External Otitis ◽

Malignant External Otitis ◽

Cranial Nerve Palsies ◽

Death Experience ◽

A Site ◽

Base Of The Skull ◽

Methods Of Treatment

Malignant external otitis is an infection which begins in the external auditory canal. It is uniformly caused by the Gram negative Pseudomonas aeruginosa organism and mainly affects elderly diabetics. It spreads to the soft tissues beneath the temporal bone and, if not properly treated leads to facial nerve palsy, mastoiditis, sepsis, osteomyelitis of the base of the skull, sigmoid sinus thrombosis, multiple cranial nerve palsies and death. Experience with 72 patients in varying stages of the disease is summarized. Stressed are the diagnostic criteria of nonresponsiveness to the usual methods of treatment, continued suppuration, and the continuing reformation of granulation tissue in the floor of the external auditory canal. Medical treatment is recommended with hospitalization and intravenous carbenicillin and gentamicin. Minor surgical debridement is helpful. All patients should be treated medically for as long as improvement continues, reserving surgical intervention only in the event a plateau is reached or symptoms and signs become worse under treatment. With or without a major surgical procedure, it is imperative to continue treatment for at least seven days after apparent cure in order to avoid recurrent disease possibly at a site distant from the canal.

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