From the Guidelines
Malignant external otitis is a severe infection that requires aggressive treatment, including antimicrobial therapy, surgical debridement, and strict glycemic control in diabetic patients, as stated in the clinical practice guideline by 1. The symptoms of malignant external otitis include severe pain, discharge, and hearing loss, and it is essential to identify patients with underlying conditions such as diabetes or immunocompromised states, as they are more susceptible to this condition.
- The treatment of malignant external otitis involves:
- Aggressive antimicrobial therapy with ciprofloxacin or levofloxacin for 6-8 weeks
- Surgical debridement to remove necrotic tissue and improve antibiotic penetration
- Strict glycemic control in diabetic patients, aiming for blood glucose levels below 180 mg/dL
- Pain management and regular cleaning of the ear canal
- Monitoring of treatment response with clinical examinations, inflammatory markers, and imaging studies
- It is crucial to note that aural lavage should be avoided in diabetic or immunocompromised patients, as it may contribute to the development of malignant otitis externa, as mentioned in the study by 1.
- The management of malignant external otitis should be individualized, taking into account the patient's underlying condition, the severity of the infection, and the response to treatment.
- Early intervention is crucial, as malignant external otitis can be life-threatening if left untreated or if skull base osteomyelitis develops, as highlighted in the study by 1.
- In addition to antimicrobial therapy and surgical debridement, supportive measures such as pain management, regular cleaning of the ear canal, and keeping the ear dry are essential to improve outcomes and reduce morbidity, as stated in the study by 1.
From the Research
Symptoms of Malignant External Otitis
- Severe persistent otalgia (pain out of proportion to exam)
- Purulent otorrhea
- Granulation tissue in the external auditory canal
- Diffuse external otitis
- Facial nerve palsy 2, 3
Treatment of Malignant External Otitis
- Control of diabetes mellitus
- Antibiotic treatment with pseudomonal coverage
- Debridement of necrotic tissue
- Aggressive surgical management in some cases
- Hyperbaric oxygen therapy in cases of facial nerve palsy 2, 3, 4, 5
Patient Population
- Elderly patients with diabetes mellitus
- Immunocompromised patients
- Patients with advanced age
- Patients with chronic renal failure on dialysis 2, 3, 6
Diagnosis and Monitoring
- Computed tomography (CT) with intravenous contrast
- Culture of external auditory canal drainage
- Erythrocyte sedimentation rate
- Radioisotope scanning
- Monitoring of therapy response through normalization of erythrocyte sedimentation rate, control of diabetes mellitus, and improvement of computed tomography and radioisotope scanning 2, 3