From the Guidelines
Malignant otitis externa in a patient with diabetes mellitus (DM) requires prompt and aggressive management.
Key Considerations
- The patient's diabetes status increases the risk of complications and poor outcomes, making it essential to involve a multidisciplinary team in their care 1.
- Malignant otitis externa is a severe infection that can progress rapidly, and hospitalization may be necessary to ensure timely and appropriate treatment 1.
- The management of malignant otitis externa in a patient with DM involves:
- Antibiotic therapy: selecting an appropriate antibiotic regimen based on the severity of the infection and the patient's overall health status 1.
- Wound care: proper wound care and debridement to promote healing and prevent further complications 1.
- Glycemic control: achieving adequate glycemic control to support the healing process and prevent further complications 1.
- Pain management: adequate pain management to improve the patient's quality of life and facilitate wound care 1.
Evidence-Based Recommendations
- The Infectious Diseases Society of America (IDSA) recommends that patients with severe infections, such as malignant otitis externa, be hospitalized for prompt treatment and close monitoring 1.
- The IDSA also recommends that patients with diabetes-related foot infections, including malignant otitis externa, receive care from a multidisciplinary team, including specialists in infectious diseases, podiatry, and wound care 1.
- The International Working Group on the Diabetic Foot (IWGDF) recommends that patients with diabetes-related foot infections, including malignant otitis externa, receive prompt and aggressive treatment, including antibiotic therapy and wound care, to prevent further complications and improve outcomes 1.
From the Research
Management of Malignant Otitis Externa in Patients with Diabetes Mellitus
The management of malignant otitis externa (MOE) in patients with diabetes mellitus (DM) involves a combination of medical and surgical interventions.
- Control of diabetes is crucial in the management of MOE, as it helps to prevent the progression of the disease and reduce the risk of complications 2, 3.
- Antipseudomonal antibiotics are the mainstay of treatment for MOE, and should be administered for a period of 4-8 weeks 4.
- Debridement of necrotic tissue and local antibiotic treatment may also be necessary to control the disease 2.
- Surgical intervention, such as tympanomastoidectomy or external auditory canal debridement and biopsy, may be required in some cases, particularly in patients with poor facial nerve function at presentation 5.
- Hyperbaric oxygen therapy may also be beneficial in patients with facial nerve palsy 2, 3.
Monitoring of Therapy Response
Monitoring of therapy response is crucial in the management of MOE, and can be done through:
- Normalization of erythrocyte sedimentation rate (ESR) 2, 3
- Control of diabetes mellitus 2, 3
- Improvement of computed tomography (CT) and radioisotope scanning 2, 3
- Close monitoring of inflammatory parameters, such as inflammatory markers and Peleg staging, can also help to predict the prognosis of MOE 3
Role of Surgery
The role of surgery in the management of MOE is still debated, and the decision to operate should be made on a case-by-case basis.
- Surgical intervention may be necessary in patients with poor facial nerve function at presentation, or in those with significant bony destruction or cranial nerve involvement 5.
- However, surgical intervention did not appear to lower the length of stay, the rate of hospital readmission, or overall mortality in one study 5.