[Malignant external otitis. Experience with 12 cases]

Malignant external otitis is a life-threatening infection occurring in aging diabetic and immunocompromised patients. The development of new antimicrobial and diagnostic aids has modified the therapy and prognosis of the disease. We describe our experience in 12 cases seen between 1982 and 1991, and review the diagnostic and therapeutic criteria during this lapse. Ten cases were males and 11 were diabetics. The most common symptoms were unilateral otalgia and otorrhea. All had edema of the external auditory channel and nine, proliferation of granulation tissue. Four had cranial nerve palsy. In ten patients Pseudomonas aeruginosa was recovered. All had axial computed tomographic scans and six sequential radionuclide scanning performed at diagnosis and follow-up. Eleven patients received combined therapy with an aminoglucoside and an anti-pseudonomas beta-lactam antibiotic; in four ambulatory treatment was continued with a quinolone. Only one patient received a quinolone as only treatment due to unavailability of other drugs in the mexican market. Presentation of granulation tissue or bone sequestrum was performed in nine patients. Only three required extensive surgical debridement procedures. We conclude that a combined antimicrobial therapy and the use of quinolones has favorably modified the prognosis and avoids extensive surgery and disminishes hospital stay.