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Malignant otitis externa: An updated review
José Luis Treviño González1, Laura Lisset Reyes Suárez1, Jesús Eduardo Hernández de León1
1Department of Otolaryngology and Head and Neck Surgery, University of Nuevo Leon, Mexico.
Abstract:
Malignant otitis externa is a progressive infection of the external auditory canal and skull base. Pseudomonas aeruginosa is the most isolated microorganism and it affects mostly to diabetic, elderly, and immunocompromised individuals. Non-resolving otalgia and chronic otorrhea are the clinical manifestations presented. Facial nerve palsy is a common and well recognized complication. (Computed tomography) CT scan is useful for initial assessment, Technetium-99m is highly sensitive and is part of the protocol for diagnosis. Treatment should be individualized, with multidisciplinary cooperation among specialties. Management involves systemic antipseudomonal antibiotics and monitoring with radiologic techniques, it also involves the strict control of diabetes. It is essential to follow up the patients for at least a year post-treatment. In refractory malignant otitis externa and affection of facial nerve, surgical management is recommended. We reviewed the most recent studies on epidemiology, clinical manifestations, diagnosis, and treatment to provide an update on Malignant Otitis Externa that can offer an overview for clinical practice and future research.
Insights
Malignant otitis externa, a severe Pseudomonas aeruginosa infection, primarily affects diabetics and the elderly. Prompt diagnosis and individualized treatment, including antibiotics and diabetes control, are crucial for patient outcomes.
Area of Science:
- Infectious Diseases
- Otolaryngology
- Radiology
Background:
- Malignant otitis externa (MOE) is a severe necrotizing infection of the external auditory canal and skull base.
- Pseudomonas aeruginosa is the predominant pathogen, frequently affecting diabetic, elderly, and immunocompromised individuals.
- Key clinical signs include persistent otalgia, chronic otorrhea, and potential facial nerve palsy.
Purpose of the Study:
- To provide an updated review of malignant otitis externa.
- To cover epidemiology, clinical manifestations, diagnosis, and treatment strategies.
- To offer insights for clinical practice and future research.
Main Methods:
- Review of recent scientific literature on malignant otitis externa.
- Analysis of diagnostic modalities including computed tomography (CT) and Technetium-99m scans.
- Evaluation of current treatment protocols and management strategies.
Main Results:
- MOE is a progressive infection with characteristic clinical presentations.
- Diagnostic imaging like CT and Technetium-99m scintigraphy are vital.
- Treatment necessitates a multidisciplinary approach with systemic antibiotics and strict diabetes management.
Conclusions:
- Individualized treatment plans are essential for managing malignant otitis externa.
- Long-term patient follow-up (at least one year) is critical post-treatment.
- Surgical intervention may be required for refractory cases or facial nerve involvement.
