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Malignant otitis externa--a high index of suspicion is still needed for diagnosis
P Walshe1, M Cleary, Walsh R McConn
1Department of Otolaryngology/Head and Neck Surgery, RCSI Education and Research Centre, Beaumont Hospital, Dublin. rmwalsh@rcsi.ie
Abstract:
Malignant otitis externa is a destructive inflammatory process of the petrous temporal bone which if untreated leads to osteomyelitis of the skull base and can be fatal. It is more common in immunocompromised and elderly insulin-dependant diabetic patients and is caused by infection with Pseudomonas species. Despite a range of laboratory and radiological tests it still remains difficult to diagnose, particularly in the early stages when it can be treated medically. We describe three cases which presented to this department in the past twelve months. In all cases the diagnosis was made clinically and confirmed per-operatively. Interestingly all three cases were relatively young patients who did not have an immunocompromised status and were not diabetic.
Insights
Malignant otitis externa, a severe skull base infection, is difficult to diagnose early. This study highlights clinical diagnosis in younger, non-diabetic patients, suggesting broader diagnostic considerations.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Skull Base Osteomyelitis
Background:
- Malignant otitis externa (MOE) is a severe necrotizing infection of the external auditory canal and skull base.
- Typically affects immunocompromised or elderly diabetic patients, caused by Pseudomonas aeruginosa.
- Early diagnosis is challenging despite advanced imaging and lab tests, hindering timely medical treatment.
Observation:
- Presents three cases of MOE diagnosed clinically over twelve months.
- All patients were relatively young and lacked typical risk factors like immunocompromise or diabetes.
- Diagnosis was confirmed intraoperatively after clinical suspicion.
Findings:
- Clinical presentation was key to diagnosing MOE in these atypical cases.
- The typical patient profile for MOE may not encompass all presentations.
- Early clinical suspicion is crucial for prompt management.
Implications:
- Broadens the clinical suspicion for malignant otitis externa beyond traditional risk groups.
- Emphasizes the importance of clinical acumen in diagnosing challenging infections.
- Suggests a need to re-evaluate diagnostic criteria and patient populations for MOE.