Malignant otitis externa: experience with hyperbaric oxygen therapy

Area of Science:

• Otolaryngology
• Infectious Diseases
• Hyperbaric Medicine

Background:

• Malignant otitis externa (MOE) is a rare condition, precluding prospective controlled studies.
• Therapeutic decisions rely on retrospective case series, with limited evidence advancement.

Discussion:

• Multimodal therapy, incorporating hyperbaric oxygen therapy (HBOT), shows reduced mortality in MOE compared to historical reports without HBOT.
• The precise contribution of HBOT to MOE treatment remains uncertain due to historical variations in antibiotics and surgical interventions.
• Necrotic tissue, unresponsive to HBOT, can impede healing in this necrotizing infection.

Key Insights:

• The largest case series to date confirms reduced mortality with multimodal therapy including HBOT for malignant otitis externa.
• Intracranial propagation of infection is associated with a poor prognosis in MOE, warranting further study.
• A low number of surgical debridements were needed in this patient group.

Outlook:

• Further research is needed to clarify the specific role and efficacy of hyperbaric oxygen therapy in malignant otitis externa management.
• Investigating outcomes in high-risk subgroups, such as those with intracranial spread, is crucial.
• Continued emphasis on multimodal therapy, guided by clinical experience, is recommended for MOE treatment.