From the Guidelines
Malignant otitis externa in patients with diabetes mellitus requires prompt and aggressive management.
Key Principles of Management
- Multidisciplinary approach: Involving specialists from infectious diseases, endocrinology, and surgery to provide comprehensive care 1.
- Antibiotic therapy: Selecting empirical and then definitive antimicrobial therapy based on culture results and susceptibility patterns 1.
- Wound care: Providing optimal wound care, including debridement and off-loading, to promote healing and prevent further complications 1.
- Glycemic control: Achieving adequate glycemic control to enhance wound healing and prevent infection 1.
- Surgical intervention: Considering surgical intervention for severe infections or those that do not respond to medical therapy 1.
Specific Management Strategies
- Diagnosis: Obtaining appropriate specimens for culture and using imaging studies, such as MRI, to diagnose osteomyelitis and other complications 1.
- Antibiotic selection: Choosing antibiotics that cover common pathogens, including Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus species 1.
- Duration of therapy: Treating for an adequate duration, typically 4-6 weeks, to ensure complete resolution of infection 1.
- Follow-up: Monitoring patients closely for signs of treatment failure or complications, and adjusting the management plan as needed 1.
Important Considerations
- Hospitalization: Considering hospitalization for patients with severe infections, those who require intravenous antibiotics, or those with significant comorbidities 1.
- Patient education: Educating patients on proper wound care, off-loading, and glycemic control to enhance healing and prevent recurrence 1.
- Collaboration: Collaborating with other healthcare professionals to ensure comprehensive care and optimal outcomes for patients with malignant otitis externa and diabetes mellitus 1.
From the Research
Management of Malignant Otitis Externa
The management of malignant otitis externa in patients with diabetes mellitus involves a combination of treatments, including:
- Control of diabetes mellitus 2, 3, 4
- Antibiotic therapy, with the most common causative agent being Pseudomonas aeruginosa 2, 3, 4
- Debridement of necrotic tissue 2, 4
- Aggressive surgical management in some cases 2, 5, 4
- Hyperbaric oxygen therapy for patients with facial nerve palsy 2, 5, 4
- Monitoring of therapy response through normalization of erythrocyte sedimentation rate, control of diabetes mellitus, and improvement of computed tomography and radioisotope scanning 2
Treatment Outcomes
The outcomes of treatment for malignant otitis externa can be affected by several factors, including:
- Presence of diabetes mellitus 6
- Facial nerve palsy 6
- Positive CT scan 6
- Age above 70 6
- Disease-specific mortality rate of 14% 6
- Overall survival rate of 38% in 5 years 6
Diagnostic Approaches
Diagnosis of malignant otitis externa can be elusive, requiring a high index of suspicion, various laboratory and imaging modalities, and histologic exclusion of malignancy 4. Imaging techniques such as computed tomography and magnetic resonance imaging can play synergistic roles in the management of malignant otitis externa 3.