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[Malignant otitis externa and diabetes: report of 4 cases]
A Lecube Torelló1, C Hernández Pascual, J Lorente Guerrero
1Sección de Endocrinología, Hospital General Universitario Vall d'Hebron, Barcelona.
Abstract:
Malignant otitis externa (MOE) is an uncommon infective but potentially fatal entity caused by Pseudomonas aeruginosa. It involves almost exclusively advanced aged diabetic patients. We report here four cases diagnosed at our hospital during the last 7 years. Clinical manifestations included otalgia, purulent otorrhoea, involvement of different cranial nerves and bony destruction; one patient died because of bronchoaspiration and two are alive but with sequelae. MOE should be suspected in every diabetic patient with otitis which goes unresolved with the usual antibiotic therapy. On the other hand, facial palsy should not always be attributed to a diabetic mononeuropathy and the presence of MOE should be ruled out when otitis coexists or precedes it.
Insights
Malignant otitis externa (MOE), a severe Pseudomonas aeruginosa infection, primarily affects elderly diabetics. Suspect MOE in diabetic patients with persistent otitis, as it can cause cranial nerve issues and bony destruction.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Diabetology
Background:
- Malignant otitis externa (MOE) is a rare, aggressive infection.
- Pseudomonas aeruginosa is the primary causative agent.
- MOE predominantly affects elderly patients with diabetes mellitus.
Observation:
- Four cases of MOE were diagnosed over seven years.
- Clinical signs included severe ear pain, discharge, cranial nerve palsies, and bone destruction.
- Outcomes varied, with one fatality due to bronchoaspiration and two patients experiencing sequelae.
Findings:
- MOE requires high clinical suspicion in diabetic patients with refractory otitis.
- Facial palsy in diabetics may indicate MOE, not solely diabetic mononeuropathy.
- Early diagnosis and intervention are critical for improved outcomes.
Implications:
- Clinicians should consider MOE in diabetic patients with persistent ear infections.
- Facial nerve involvement warrants investigation for MOE, especially with coexisting otitis.
- Prompt recognition and management of MOE can prevent severe complications and mortality.