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From the Research
Management Approach for Suspected Malignant Otitis Externa (MOE) in a Patient with Diabetes Mellitus (DM)
The management approach for suspected MOE in a patient with DM involves several key steps:
- Early consultation with an otolaryngologist is recommended 1
- Antibiotics with pseudomonal coverage are needed, as Pseudomonas aeruginosa is the most common causative agent of MOE 1, 2, 3
- Most patients with MOE will require admission to the hospital 1
- Diagnosis is aided by computed tomography (CT) with intravenous contrast, which may demonstrate bony destruction of the temporal bone or skull base 1
- Culture of external auditory canal (EAC) drainage should be performed to identify the causative agent 1
- Red flags for MOE include severe otalgia, neurologic deficits, previously diagnosed otitis externa not responsive to therapy, and patients with major risk factors for MOE, such as diabetes mellitus 1
Treatment Options
Treatment options for MOE include:
- A 6-week course of intravenous antibiotics, such as ciprofloxacin, piperacillin, and tazobactam 2
- Local debridement and local and systemic antibiotic treatment 4
- Facial nerve decompression in cases of facial nerve palsy 4
- Hyperbaric oxygen therapy in cases of facial nerve palsy 4
- Aggressive surgical management in some cases 4
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment of MOE are crucial to prevent complications and improve outcomes 1, 2, 3, 4