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
The management of malignant otitis externa in patients with diabetes mellitus involves a combination of treatments, including:
- Control of diabetes mellitus 1, 2, 3
- Antibiotic therapy, with the most common pathogens being Pseudomonas aeruginosa 1, 2, 4
- Debridement of necrotic tissue 1, 5
- Surgical management, which may include facial nerve decompression 1, 5
- Hyperbaric oxygen therapy, which may be used in cases of facial nerve palsy 1, 5
- Monitoring of therapy response through normalization of erythrocyte sedimentation rate, control of diabetes mellitus, and improvement of computed tomography and radioisotope scanning 1
Treatment Outcomes
The outcomes of treatment for malignant otitis externa can be poor, with a 5-year survival rate of 38% and a disease-specific mortality rate of 14% 4. Factors that predict poor outcomes include:
- Presence of diabetes mellitus 4
- Facial nerve palsy 4
- Positive CT scan 4
- Age above 70 4
- Presence of two or more of these factors 4
Diagnostic Considerations
Diagnosis of malignant otitis externa should be suspected in elderly diabetic patients with persistent otalgia and external otitis 2, 3. Imaging studies, such as computed tomography and magnetic resonance imaging, can play a synergistic role in the management of the disease 2. Ear swabs for culture and sensitivity can help identify the causative pathogen, which is often Pseudomonas aeruginosa 1, 2, 4.