Short Notes on Malignant otitis externa:
Definition: This is an inflammatory disorder involving the external auditory canal,
hence the term malignant otitis external is a misnomer. It is caused by Pseudomonas group of
organisms. This condition is termed as malignant otitis externa because of its
propensity to cause complications and death.
Commonly this condition affects elderly diabetics. It is very rare in children.
Clinical features:
1. Pain and swelling of external auditory canal following a minor trauma to the
external caanal. Even use of ear buds is sufficient to cause this infection
2. Extensive granulations will be seen occluding the whole of the external auditory canal
3. Pain caused is extensively severe and throbbing in nature
4. Foul smelling scanty discharge from the external canal
On examination:
1. Granulation tissue could be seen at the bony cartilagenous junction.
2. External canal skin is oedematous and soggy
3. Foul smelling discharge indicates onset of osteomyelitis
4. Patient doesnot have constitutional symptoms like fever
5. Ear drum is usually normal
6. Facial nerve is commonly affected
7. Progressive disease affects lower three cranial nerves close to jugular foramen
8. Intracranial complications are also known to occur
Complications:
Infection from the external canal may spread to involve adjacent structures:
1. Facial nerve via stylomastoid foramen
2. Anterior spread may cause parotid involvement
3. Posterior spread may involved mastoid and sigmoid sinus
4. Superior spread involves meninges and brain
5. Spread of infections through vascular channels are also common
Criteria for diagnosis of malignant otitis externa:
Levenson's criteria:
1. Refractory otitis externa
2. Severe nocturnal otalgia
3. Granulation tissue in the external canal
4. Culture of pseudomonas aeruginosa from external canal
5. Diabetic elderly patients
Management:
Medical:
Aggressive managment of diabetes.
Antibiotics: Carbenicillin is the preferred drug. Ciprofloxillin can also be
administered.
Surgical: The role of surgery is limited only to wound debridement only
Prognosis: Poor
Definition: This is an inflammatory disorder involving the external auditory canal,
hence the term malignant otitis external is a misnomer. It is caused by Pseudomonas group of
organisms. This condition is termed as malignant otitis externa because of its
propensity to cause complications and death.
Commonly this condition affects elderly diabetics. It is very rare in children.
Clinical features:
1. Pain and swelling of external auditory canal following a minor trauma to the
external caanal. Even use of ear buds is sufficient to cause this infection
2. Extensive granulations will be seen occluding the whole of the external auditory canal
3. Pain caused is extensively severe and throbbing in nature
4. Foul smelling scanty discharge from the external canal
On examination:
1. Granulation tissue could be seen at the bony cartilagenous junction.
2. External canal skin is oedematous and soggy
3. Foul smelling discharge indicates onset of osteomyelitis
4. Patient doesnot have constitutional symptoms like fever
5. Ear drum is usually normal
6. Facial nerve is commonly affected
7. Progressive disease affects lower three cranial nerves close to jugular foramen
8. Intracranial complications are also known to occur
Complications:
Infection from the external canal may spread to involve adjacent structures:
1. Facial nerve via stylomastoid foramen
2. Anterior spread may cause parotid involvement
3. Posterior spread may involved mastoid and sigmoid sinus
4. Superior spread involves meninges and brain
5. Spread of infections through vascular channels are also common
Criteria for diagnosis of malignant otitis externa:
Levenson's criteria:
1. Refractory otitis externa
2. Severe nocturnal otalgia
3. Granulation tissue in the external canal
4. Culture of pseudomonas aeruginosa from external canal
5. Diabetic elderly patients
Management:
Medical:
Aggressive managment of diabetes.
Antibiotics: Carbenicillin is the preferred drug. Ciprofloxillin can also be
administered.
Surgical: The role of surgery is limited only to wound debridement only
Prognosis: Poor
Last modified: Sunday, 6 January 2008, 04:34 AM