There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the Research
Management of Malignant Otitis Externa in Patients with Diabetes Mellitus
The management of malignant otitis externa in patients with diabetes mellitus (DM) involves a comprehensive approach to control the infection and manage the underlying diabetes.
- Control of diabetes is crucial in the management of malignant otitis externa, as stated in the study by 1.
- The use of proper antibiotics, debridement of necrotic tissue, and sometimes aggressive surgical management are also essential in treating the infection, as noted in the studies by 1 and 2.
- Local debridement and local and systemic antibiotic treatment may be sufficient to control the disease in some cases, as reported in the study by 1.
- Hyperbaric oxygen therapy may be performed in cases with facial nerve palsy, as mentioned in the study by 1.
- Monitoring of therapy response is done through normalization of erythrocyte sedimentation rate, control of diabetes mellitus, and improvement of computed tomography and radioisotope scanning, as stated in the study by 1.
- Close monitoring of inflammatory parameters is also important in predicting the prognosis of malignant otitis externa, as noted in the study by 3.
- Surgical intervention may be necessary in some cases, particularly in patients with poor facial nerve function at initial presentation, as reported in the study by 2.
- The use of radioisotope scans, high-resolution computed tomography scans, and multidirectional tomograms can help delineate the extent of the disease, as mentioned in the study by 4.
- Therapy may include intravenous aminoglycoside and penicillin derivatives, limited surgery, and hyperbaric oxygenation, as noted in the study by 4.
Key Considerations
- Malignant otitis externa is a serious disease associated with cranial nerve complications and high morbidity-mortality rate, as stated in the studies by 1 and 3.
- The disease requires urgent diagnosis and treatment, as noted in the study by 1.
- Patient comorbidities, including the severity of diabetes, should be taken into account when managing malignant otitis externa, as reported in the study by 2.
- The role of surgery in the management of malignant otitis externa is still not well described, and further studies are needed to determine its impact on clinical outcomes, as noted in the study by 2.
Treatment Outcomes
- Long-term outcomes for patients with malignant otitis externa remain poor, as reported in the study by 2.
- Surgical intervention for malignant otitis externa did not appear to lower the length of stay, the rate of hospital readmission, or overall mortality in one study, as noted in the study by 2.
- However, aggressive medical management is imperative to prevent progression of the disease, as stated in the study by 5.