From the Guidelines
Malignant otitis externa in patients with diabetes mellitus requires prompt treatment with surgical debridement and systemic antibiotics.
Key Components of Treatment
- Surgical debridement to remove infected tissue and promote healing
- Systemic antibiotics to cover pseudomonal and staphylococcal infection, including methicillin-resistant S aureus, such as fluoroquinolones or cephalosporins
Diagnosis and Management
- A clinical diagnosis of necrotizing otitis externa can be confirmed with a raised erythrocyte sedimentation rate plus an abnormal computed tomography or magnetic resonance imaging scan 1
- Biopsy may be necessary to detect neoplasia if the diagnosis of malignant otitis externa is uncertain or response to therapy is incomplete
- Patients with diabetes are more likely to require systemic antibiotics and should not have their ear canals irrigated to remove debris, as it may predispose to necrotizing otitis externa 1
Important Considerations
- Pseudomonas aeruginosa is isolated from exudate in the ear canal in more than 90% of cases of necrotizing otitis externa 1
- Facial nerve paralysis may be an early sign of necrotizing otitis externa, with the glossopharyngeal and spinal accessory nerves less frequently involved 1
From the Research
Treatment Overview
The treatment for malignant otitis externa (MOE) in patients with diabetes mellitus typically involves medical management with antibiotics, with surgery not being the primary indication 2, 3.
Antibiotic Therapy
- The use of antipseudomonal antibiotics, such as third-generation cephalosporins (e.g., ceftazidime or ceftriaxone) and fluoroquinolones (e.g., ciprofloxacin or ofloxacin), is recommended for the treatment of MOE 2, 4.
- The duration of antibiotic therapy can range from four to eight weeks 3.
- Hyperbaric oxygen therapy may also be used in some cases, if there are no contraindications 2.
Surgical Intervention
- Surgery is not typically indicated for MOE, except in cases where there is significant tissue necrosis or other complications 2, 3.
- A study found that surgical intervention did not appear to lower the length of stay, the rate of hospital readmission, or overall mortality in patients with MOE 5.
- However, patients with poor facial nerve function at presentation may be more likely to undergo surgical intervention 5.
Disease Management
- The management of MOE requires a comprehensive approach, including the treatment of underlying diabetes mellitus and the use of diagnostic radiologic modalities to monitor the disease 4, 3.
- The disease can result in significant morbidity and mortality, with a reported mortality rate of around 20% despite antibiotic therapy 3.
- A high cure rate of 76.2% has been reported with the use of antimicrobial therapy, although recurrence is common 4.