From the Guidelines
Malignant (necrotizing) otitis externa is a severe infection that requires prompt treatment with surgical debridement and antibiotics.
Management
- The management of malignant otitis externa involves a combination of surgical debridement, antibiotic therapy, and supportive care.
- Surgical debridement is necessary to remove necrotic tissue and promote healing 1.
- Antibiotic therapy should be targeted against Pseudomonas aeruginosa and other gram-negative bacilli, which are commonly implicated in this infection.
- Supportive care includes pain management, wound care, and monitoring for complications such as cranial nerve involvement.
Antibiotic Therapy
- The choice of antibiotic therapy should be based on culture and sensitivity results, but fluoroquinolones or cephalosporins with antipseudomonal activity are commonly used.
- Antifungal therapy may also be necessary in some cases, particularly if there is evidence of fungal infection 1.
Important Considerations
- Malignant otitis externa is a serious infection that requires prompt treatment to prevent complications and improve outcomes.
- Immunocompromised patients are at higher risk for developing this infection and may require more aggressive treatment 1.
- Cranial nerve involvement is a common complication of malignant otitis externa and should be monitored closely 1.
From the Research
Management of Malignant Otitis Externa
The management of malignant otitis externa involves a combination of medical and surgical interventions.
- Antibiotic treatment is the primary approach, with intravenous ceftazidime and oral fluoroquinolone being commonly used 2.
- Local debridement of necrotic tissue is also essential in controlling the disease 3, 4.
- In some cases, aggressive surgical management may be necessary, including facial nerve decompression 4.
- Hyperbaric oxygen therapy has been proposed as an adjunctive therapy, particularly in cases with facial nerve palsy or severe disease 5, 4.
Monitoring and Prognosis
Monitoring of therapy response is crucial in managing malignant otitis externa.
- Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels can be used to monitor disease activity and response to treatment 2, 4.
- Normalization of ESR and control of diabetes mellitus are important indicators of treatment response 4.
- The presence of comorbidities, such as diabetes mellitus, and cranial nerve involvement can affect treatment outcomes and prognosis 3, 6.
- Early diagnosis and initiation of aggressive therapy are essential in preventing serious complications and improving treatment outcomes 6.
Treatment Outcomes
The treatment outcomes for malignant otitis externa vary depending on several factors, including the severity of the disease, presence of comorbidities, and response to treatment.
- A study found that 63.2% of patients had resolution of disease after 6 weeks of antibiotic treatment, while 21.1% had mortality 2.
- Another study reported that all patients treated with hyperbaric oxygen therapy were considered free of disease after treatment, with no fatalities due to malignant otitis externa 5.
- The presence of cranial nerve involvement, erosion of temporal bone, and comorbidities can affect treatment outcomes and prognosis, with patients experiencing prolonged treatment and adverse prognosis 6.