From the Guidelines
Malignant otitis externa in a patient with diabetes mellitus (DM) should be managed with aggressive treatment, including systemic antifungal therapy and local measures.
Key Considerations
- Patients with DM are susceptible to recurrent bacterial otitis media, otitis externa, and Aspergillus otomycosis due to impaired mucosal or cutaneous immunity 1.
- Aspergillus otomycosis may involve the middle ear if the tympanic membrane has been perforated, and can lead to chronic fungal mastoiditis if left untreated 1.
- Topical therapy using irrigations with acetic acid or boric acid may be beneficial, as well as topical antifungal creams and ointments 1.
- Orally administered antifungals such as itraconazole, voriconazole, or posaconazole may be effective, but there are no published studies to support their use 1.
Treatment Approach
- In immunocompromised patients, such as those with DM, systemic antifungal therapy appears necessary 1.
- Local measures, including cerumen removal, may be used in addition to systemic therapy 1.
- A variety of topical therapeutic options have been used, including cresylate, alcohol, nystatin, amphotericin B 3% topical solution, and others 1.
From the Research
Management of Malignant Otitis Externa
The management of malignant otitis externa in a patient with diabetes mellitus (DM) involves a combination of treatments, including:
- Control of diabetes mellitus 2, 3, 4, 5
- Antibiotic therapy, with the most common pathogens being Pseudomonas aeruginosa 2, 3, 4, 5
- Debridement of necrotic tissue 2, 3
- Aggressive surgical management in some cases 2, 3, 4, 5
- Hyperbaric oxygen therapy in cases of facial nerve palsy 2, 3, 6, 4
- Monitoring of therapy response through normalization of erythrocyte sedimentation rate, control of diabetes mellitus, and improvement of computed tomography and radioisotope scanning 2, 6, 4, 5
Treatment Outcomes
The outcomes of treatment for malignant otitis externa can be predicted by various factors, including:
- Inflammatory markers and Peleg staging 6
- Presence of facial nerve palsy 2, 5
- Positive CT scan 5
- Age above 70 5
- Presence of diabetes mellitus 2, 3, 4, 5
Diagnostic Tools
The diagnosis of malignant otitis externa can be aided by various tools, including: