From the Guidelines
Management of Malignant Otitis Externa in Diabetic Patients
The management of malignant otitis externa in patients with Diabetes Mellitus (DM) involves aggressive treatment with systemic antibiotics and surgical debridement to prevent complications such as skull base osteomyelitis and cranial nerve involvement 1.
- Initial treatment should include systemic antibiotics that cover pseudomonal and staphylococcal infections, including methicillin-resistant Staphylococcus aureus, such as ciprofloxacin and cefepime 1.
- Surgical debridement is essential to remove granulation tissue and necrotic debris, which can help prevent the spread of infection to surrounding tissues 1.
- Tight glycemic control is crucial in diabetic patients to prevent worsening of the infection, with a target hemoglobin A1c level of less than 7% 1.
- Local wound care, including topical antimicrobial therapy and debridement, is also essential to promote healing and prevent further complications 1.
- In severe cases, surgical intervention may be necessary to manage complications such as cranial nerve involvement or abscess formation 1.
- 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, and biopsy may be necessary to detect neoplasia if the diagnosis is uncertain or response to therapy is incomplete 1.
From the Research
Management of Malignant Otitis Externa in Patients with Diabetes Mellitus
The management of malignant otitis externa (MOE) in patients with diabetes mellitus (DM) involves a combination of medical and surgical interventions.
- Medical management includes the use of long-term broad-spectrum antibiotics, such as fluoroquinolones and third-generation cephalosporins 2.
- Surgical intervention may be necessary in some cases, including debridement of the external auditory canal and biopsy 3, 4.
- The decision to undergo surgical intervention is often based on the presence of complications, such as poor facial nerve function 3.
- Prompt diagnosis and treatment of MOE are crucial to prevent complications, such as cranial nerve involvement and intracranial infections 5, 4.
Treatment Outcomes
- The treatment outcomes for MOE patients with DM are generally good, with a pooled cure rate of 76.2% from antimicrobial usage 2.
- However, some patients may experience complications, such as pseudoaneurysm formation, which can be life-threatening 5.
- The severity of diabetes, as measured by HbA1c levels, can impact the treatment outcomes, with poorly controlled diabetes associated with a higher risk of complications 2.
Role of Surgery
- The role of surgery in the management of MOE is still debated, with some studies suggesting that it may not improve outcomes in terms of length of stay, readmission rates, or overall mortality 3.
- However, surgical intervention may be necessary in cases where medical management is not effective, or where complications have developed 4.