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Malignant external otitis: Factors predicting patient outcomes
Sagit Stern Shavit1, Ethan Soudry1, Yaniv Hamzany1
1Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Objective:
Malignant external otitis (MEO) is an aggressive infection, primarily affecting elderly diabetic patients. It begins in the external ear canal and spreads to adjacent structures. This study investigated the clinical characteristics of patients diagnosed and treated for MEO and analyzed factors affecting patient outcomes.
Study Design:
Historical cohort.
Setting:
Tertiary medical center.
Methods:
Medical records of all patients diagnosed and treated for MEO from 1990 to 2013, were retrospectively reviewed. Clinical features, laboratory, imaging and outcomes were analyzed.
Results:
88 patients were included, mean age was 73±11.5years, 61 (69%) were male. Of these, 75% had diabetes. Mean follow-up was 60months. The most common presenting symptoms were otalgia (89%), external ear canal edema (86%) and otorrhea (84%). Pseudomonas aeruginosa was isolated in 61% of ear cultures. All patients were treated with antibiotics, 22% had surgery and 8% hyperbaric oxygen. Overall survival rate was 38% in 5years, with disease specific mortality 14%. DM, facial nerve palsy, positive CT scan and age above 70 were found to correlate and predict disease-specific mortality.
Conclusions:
MEO carries a grave prognosis. The presence of two or more of the following features, DM, facial nerve palsy, positive CT scan and age above 70, predicts poor outcome, and highlights the need for prolonged, vigorous treatment.
Insights
Malignant external otitis (MEO) is a severe infection in elderly diabetics. Identifying risk factors like diabetes and facial nerve palsy is crucial for predicting poor outcomes and guiding aggressive treatment.
Area of Science:
- Infectious Diseases
- Otolaryngology
- Geriatrics
Background:
- Malignant external otitis (MEO) is an aggressive infection impacting the ear canal and surrounding tissues.
- Elderly patients with diabetes mellitus are the primary demographic affected by MEO.
Purpose of the Study:
- To investigate the clinical characteristics of patients diagnosed with MEO.
- To analyze factors influencing patient outcomes in MEO cases.
Main Methods:
- A retrospective review of medical records for 88 MEO patients treated between 1990 and 2013.
- Analysis of clinical features, laboratory results, imaging, and patient outcomes.
Main Results:
- The most common symptoms included ear pain, ear canal swelling, and discharge.
- Pseudomonas aeruginosa was the predominant pathogen (61%).
- Factors predicting disease-specific mortality included diabetes, facial nerve palsy, positive CT scans, and age over 70.
Conclusions:
- Malignant external otitis has a poor prognosis.
- The presence of multiple risk factors (diabetes, facial nerve palsy, positive CT, age >70) indicates a need for intensive, prolonged treatment.
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