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[Malignant or necrotizing otitis externa: experience in 22 cases]
J Martel1, J Y Duclos, V Darrouzet
1Service d'ORL et de chirurgie cervico-faciale, Service de médecine nucléaire, Hôpital Pellegrin C.H.U. de Bordeaux, 33076 Bordeaux Cedex.
Abstract:
Malignant or progressive necrotizing otitis extrema is an uncommon but severe infectious condition of the external auditory canal. Over a period of four years, we treated 22 patients: 60% had diabetes (1/4 insulin dependent) and 13% were immunodepressed. The causal germ was Pseudomonas aeruginosa in 87% of cases. The pretherapeutic work-up included a computed tomography scan and a technetium scintigraphy to confirm diagnosis and assess extension. Repeated scintigraphies with gallium were used to follow the course under treatment. Medical treatment was used in most cases (16/22) with parenteral antibiotic therapy using a third-generation cephalosporin (ceftazidime or ceftriaxone) and a fluoroquinolone (ciprofloxacin or ofloxacin) and, if there was no contraindication, hyperbaric oxygen. Surgery is not indicated in malignant otitis externa. We had a 95% cure rate with only 10% recurrence. We reviewed the data in the literature on malignant otitis externa and present the important diagnostic, imaging and therapeutic aspects.
Insights
Malignant otitis externa, a severe external auditory canal infection, primarily affects diabetics and is often caused by Pseudomonas aeruginosa. Effective medical treatment, including antibiotics and hyperbaric oxygen, yields high cure rates with low recurrence.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Medical Imaging
Background:
- Malignant otitis externa (MOE) is a rare but serious infection of the external auditory canal.
- It predominantly affects elderly patients with diabetes mellitus and immunocompromised individuals.
Observation:
- A study of 22 MOE patients revealed 60% had diabetes and 13% were immunocompromised.
- Pseudomonas aeruginosa was identified as the causative agent in 87% of cases.
- Computed tomography (CT) and technetium scintigraphy were crucial for diagnosis and staging.
Findings:
- Gallium scintigraphy effectively monitored treatment response.
- Medical management, including parenteral antibiotics (ceftazidime, ceftriaxone, ciprofloxacin, ofloxacin) and hyperbaric oxygen, achieved a 95% cure rate.
- Surgery is generally not indicated for malignant otitis externa, with recurrence rates around 10%.
Implications:
- This study highlights the importance of prompt diagnosis and aggressive medical management for MOE.
- The findings support a non-surgical approach for MOE, emphasizing the efficacy of combined antibiotic and hyperbaric oxygen therapy.
- Further research into risk factors and optimal treatment strategies for MOE is warranted.