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Updated: Sep 26, 2026
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Malignant otitis externa: a review
Sangita Bhandary1, Prahlad Karki, Bimal K Sinha
1Majuro Hospital, P.O. Box 16, Marshall Islands, MH 96960, USA. sangitabhandary@hotmail.com
Abstract:
Malignant otitis externa is a rare but potentially fatal disease of the external auditory canal seen mostly among elderly, diabetic or immunocompramised patients. The causative organism is mainly Pseudomonas aeruginosa. The disease spreads rapidly, invading surrounding soft tissues, cartilage and bones causing their necrosis and even spreading to the cranial nerves. The disease can be fatal if treatment is not aggressive and timely, especially if it spreads outside the auditory canal with involvement of the cranial nerves. Treatment is mainly medical with antipseudomonal drugs like the third generation cephalosporin and the fluoroquinolones and local debridement. With aggressive treatment the mortality rate from this disease, which used to be 50% in the past has now been reduced to 10-20%. The pathophysiology of the disease, clinical presentation, diagnosis, treatment and the outcome has been discussed and reviewed.
Insights
Malignant otitis externa, a severe infection primarily affecting elderly or immunocompromised individuals, is mainly caused by Pseudomonas aeruginosa. Aggressive treatment significantly reduces mortality rates from this potentially fatal condition.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Dermatology
Background:
- Malignant otitis externa (MOE) is a rare, severe external auditory canal infection.
- Primarily affects elderly, diabetic, or immunocompromised patients.
- Often caused by Pseudomonas aeruginosa, leading to rapid tissue necrosis.
Purpose of the Study:
- To review the pathophysiology, clinical presentation, diagnosis, treatment, and outcomes of malignant otitis externa.
- To highlight the importance of aggressive and timely management.
- To discuss the reduction in mortality rates with modern treatment protocols.
Main Methods:
- Literature review of malignant otitis externa.
- Analysis of pathophysiology, clinical manifestations, and diagnostic approaches.
- Evaluation of current treatment strategies, including medical and surgical interventions.
Main Results:
- MOE can rapidly invade surrounding tissues, cartilage, and bone, potentially affecting cranial nerves.
- Timely and aggressive treatment is crucial for survival.
- Mortality rates have decreased from 50% to 10-20% with effective treatment.
Conclusions:
- Malignant otitis externa requires prompt, aggressive medical and surgical management.
- Early diagnosis and intervention significantly improve patient outcomes.
- Pseudomonas aeruginosa remains the primary pathogen, necessitating targeted antipseudomonal therapy.
