From the Guidelines
Suspected malignant otitis externa (MOE) in patients with diabetes mellitus (DM) should be managed with prompt antibiotic therapy and close monitoring.
Management Approach
- The management of MOE typically involves broad-spectrum antibiotics that cover Pseudomonas aeruginosa, the most common causative organism [not explicitly stated in 1, but based on general medical knowledge].
- Systemic antifungal therapy may be necessary in immunocompromised patients, such as those with DM, if a fungal infection is suspected [as suggested in 1 for immunocompromised patients].
- Local measures, including cerumen removal and topical therapeutic options, may be used as adjunctive therapy [as described in 1 for infections of lesser severity].
- It is essential to note that the provided evidence 1 focuses on Aspergillus infections and does not directly address the management of MOE in patients with DM. However, based on general medical knowledge, a comprehensive approach to managing MOE in patients with DM would involve aggressive antibiotic therapy, close monitoring, and management of underlying diabetes.
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 2
- Antibiotics with pseudomonal coverage are needed, as Pseudomonas aeruginosa is the most common causative agent of MOE 2, 3, 4
- Most patients with MOE will require admission to the hospital 2
- Diagnosis is aided by computed tomography (CT) with intravenous contrast, which may demonstrate bony destruction of the temporal bone or skull base 2
- Culture of external auditory canal (EAC) drainage should be performed to identify the causative agent 2
- 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 2
Treatment Options
Treatment options for MOE include:
- A 6-week course of intravenous antibiotics, such as ciprofloxacin, piperacillin, and tazobactam 3
- Local debridement and local and systemic antibiotic treatment 5
- Facial nerve decompression in cases of facial nerve palsy 5
- Hyperbaric oxygen therapy in cases of facial nerve palsy 5
- Aggressive surgical management in some cases 5
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment of MOE are crucial to prevent complications and improve outcomes 2, 3, 4, 5