Malignant otitis externa due to Staphylococcus infection

Necrotising otitis externa: clinical profile and management protocol

BACKGROUND

Necrotising otitis externa, which is typically seen in elderly diabetics, is a severe infective disorder caused by Pseudomonas aeruginosa. There is lack of standard management policy for necrotising otitis externa, hence this study attempted to frame a protocol for management based on clinical parameters.

METHOD

A retrospective study of 27 patients with necrotising otitis externa was conducted over 6 years in a tertiary care hospital. Data were analysed with regards to demographic characteristics, clinical features, investigations, staging and treatment modalities.

RESULTS

Out of 27 patients, 26 were diabetics. The commonest organism isolated was P aeruginosa, which was sensitive to third generation cephalosporins and fluoroquinolones. Nine patients had cranial nerve involvement. Twelve of 15 patients treated with medical therapy recovered, as did 11 of 12 patients that underwent surgery.

CONCLUSION

A high index of suspicion, early diagnosis and prompt intervention are key factors to decrease morbidity and mortality. Fluoroquinolones, third generation cephalosporins and surgical debridement are the mainstay of treatment.

Prognostic scoring in necrotising otitis externa

Objective:

To collect and analyse data from the published literature concerning the rare condition necrotising otitis externa, in order to formulate a prognostic scoring model based on signs and symptoms.

Design:

Retrospective data collection from published literature, and binary logistic regression analysis of the effect on outcome of identified signs and symptoms.

Results:

Six factors were identified as prognostic of a poorer outcome, including facial nerve involvement, additional cranial nerve involvement, non-cranial nerve neurological involvement, extensive granulations (or oedema) in the external auditory canal, bilateral symptoms and aspergillus species as the causative organism. A four-point scoring model based on these findings is presented.

Conclusions:

A novel, systematic method of data analysis was utilised to construct a prognostic scoring model for necrotising otitis externa. This will better equip clinicians to treat this potentially fatal condition.

Malignant external otitis: treatment with prolonged usage of antibiotics and Burow's solution

Malignant external otitis is a severe infection of the external auditory canal, generally caused by Pseudomonas aeruginosa in elderly diabetics patients. We describe a case of malignant external otitis in a 63-year-old man with severe otalgia, purulent otorrhea and polypoid granulation of the external auditory canal. Local debridement, insulin treatment and 6-week intravenous antibiotic therapy with carbapemens were very effective and the granulation tissue disappeared completely. However, the patient readmitted for recurrent disease 3 weeks later, despite the oral and ear drop administration with new quinolone. No recurrence has been noted after 4-week additional treatment with intravenous carbapenems followed by 3-week treatment with Burow's solution as ear drops.

A case of malignant otitis externa following mastoidectomy

We present a case of a 63-year-old diabetic male who developed malignant otitis externa following mastoidectomy. Extensive skull base osteomyelitis caused thrombosis of the jugular bulb and subsequent paralysis of cranial nerves VII, IX, X and XII. He was treated aggressively with intravenous antibiotics and debridement of granulation tissue in the mastoid bowl with full recovery of the cranial nerve palsies associated with recanalization of the jugular bulb. We believe this is the first reported case of malignant otitis externa to occur following mastoidectomy with complete recovery of the cranial nerve paresis.

Another hazard of ear syringing: malignant external otitis

A case of malignant external otitis is presented. This occurred in a healthy 72-year-old non-diabetic, non-immuno-compromised man after ear syringing. The infection was treated with oral ciprofloxacin for eight weeks with complete resolution.