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Malignant otitis externa

Matthew J Carfrae1, Bradley W Kesser

  • 1Department of Otolaryngology - Head and Neck Surgery, Division of Otology-Neurotology, University of Virginia Health System, Box 800713, 1 Hospital Drive, Old Medical School, 2nd Floor, Charlottesville, VA 22908, USA.

Otolaryngologic Clinics of North America
|April 26, 2008
PubMed

Insights

Malignant otitis externa, a severe ear infection, demands prompt diagnosis and treatment, especially in diabetic patients. Emerging antibiotic resistance necessitates considering alternative treatments beyond standard antipseudomonal agents.

Area of Science:

  • Infectious Diseases
  • Otolaryngology
  • Diabetology

Background:

  • Malignant otitis externa (MOE) is a serious, invasive infection impacting the external ear and skull base.
  • It disproportionately affects immunocompromised individuals, notably those with diabetes mellitus.
  • Pseudomonas aeruginosa is the primary pathogen, though resistance is a growing concern.

Purpose of the Study:

  • To summarize the diagnostic challenges and treatment strategies for malignant otitis externa.
  • To highlight the increasing issue of Pseudomonas aeruginosa antibiotic resistance.
  • To underscore the importance of considering alternative pathogens and therapies.

Main Methods:

  • Review of current literature on MOE diagnosis and management.
  • Analysis of causative agents, including Pseudomonas aeruginosa and other potential pathogens.
  • Evaluation of treatment outcomes with antipseudomonal agents and adjunctive therapies.

Main Results:

  • Diagnosis of MOE is often delayed, requiring high clinical suspicion and multimodal investigations.
  • Long-term oral antipseudomonal therapy is effective but challenged by emerging resistance.
  • Alternative bacterial and fungal agents should be considered in treatment-resistant cases.

Conclusions:

  • Prompt diagnosis and treatment are critical for managing malignant otitis externa.
  • The rise of Pseudomonas aeruginosa antibiotic resistance necessitates a broader etiological and therapeutic approach.
  • Aggressive debridement and hyperbaric oxygen therapy are valuable for refractory cases.

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