What is the management of malignant otitis externa in patients with Diabetes Mellitus (DM)?

From the Guidelines

Malignant otitis externa in patients with Diabetes Mellitus (DM) should be managed with a combination of local measures and systemic antifungal therapy.

Management Approach

• Local measures such as cerumen removal and topical antifungal agents like acetic acid or boric acid irrigations may be beneficial 1.
• Systemic antifungal therapy with agents like itraconazole, voriconazole, or posaconazole may be effective, although there are no published studies to support their use 1.
• In cases of invasive infection or in immunocompromised patients, systemic antifungal therapy appears necessary 1.

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 may extend into the mastoid sinus, creating a chronic fungal mastoiditis if left untreated 1.
• Topical antifungal creams and ointments may be useful, but are not well studied 1.

From the Research

Management of Malignant Otitis Externa in Patients with Diabetes Mellitus (DM)

The management of malignant otitis externa in patients with Diabetes Mellitus (DM) involves a combination of medical and surgical interventions.

• Control of diabetes is crucial in the management of malignant otitis externa, as uncontrolled diabetes can lead to poor outcomes 2, 3, 4.
• Antibiotic therapy is the mainstay of treatment, with the choice of antibiotic depending on the results of bacterial culture and sensitivity tests 2, 3, 4.
• Surgical intervention may be necessary in some cases, such as those with poor facial nerve function or extensive disease 3, 5.
• Debridement of necrotic tissue and hyperbaric oxygen therapy may also be used as adjunctive treatments 6, 3.

Monitoring of Therapy Response

Monitoring of therapy response is crucial in the management of malignant otitis externa.

• Inflammatory markers, such as erythrocyte sedimentation rate, can be used to monitor the response to treatment 6, 3.
• Imaging modalities, such as computed tomography and scintigraphy, can be used to evaluate the extent of disease and monitor the response to treatment 6, 3, 4.
• Close monitoring of clinical parameters, such as pain and discharge, is also important in assessing the response to treatment 2, 6, 3.

Predictors of Outcome

Several factors have been identified as predictors of outcome in patients with malignant otitis externa.

• The presence of diabetes, facial nerve palsy, and positive CT scan are associated with poor outcomes 2.
• Age above 70 years is also a predictor of poor outcome 2.
• The presence of two or more of these factors is associated with a higher risk of disease-specific mortality 2.