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Necrotizing (malignant) external otitis.

Ophir Handzel1, Doron Halperin

  • 1Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel. ohandzel@clalit.org.il

American Family Physician
|August 2, 2003
PubMed
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Necrotizing external otitis is a rare but serious infection, often seen in diabetics. Early detection and treatment are crucial to prevent severe complications and death.

Area of Science:

  • Otolaryngology
  • Infectious Diseases
  • Immunocompromised Host

Background:

  • Necrotizing external otitis (NEO) is a severe infection of the external auditory canal, temporal, and adjacent bones.
  • It primarily affects immunocompromised individuals, particularly older adults with diabetes mellitus.
  • Trauma to the ear canal, often self-inflicted or iatrogenic, frequently initiates the infection, with Pseudomonas aeruginosa being the most common pathogen.

Purpose of the Study:

  • To describe the epidemiology, clinical presentation, diagnosis, and management of necrotizing external otitis.
  • To highlight the importance of early recognition in immunocompromised patients, especially those with diabetes.
  • To provide guidance for family physicians and other healthcare providers on managing this condition.

Main Methods:

Related Experiment Videos

  • Review of clinical findings, including severe otalgia, otorrhea, and granulation tissue in the ear canal.
  • Diagnostic methods involve culturing ear secretions and pathological examination of granulation tissue.
  • Imaging studies such as CT scans and bone/gallium scintigraphy aid in diagnosis and staging.

Main Results:

  • Facial and cranial nerve palsies are indicators of a poor prognosis.
  • Intracranial complications represent the most frequent cause of mortality.
  • Treatment involves addressing immunosuppression, local ear care, prolonged antibiotics, and potentially surgery.

Conclusions:

  • Family physicians must maintain a high index of suspicion for NEO in immunocompromised patients with refractory otitis and otalgia, especially if diabetic.
  • Patient education on avoiding ear canal manipulation and minimizing water exposure is vital.
  • Prompt referral to an otolaryngologist is essential for appropriate management.