Malignant otitis externa: Difference between revisions
No edit summary |
|||
| Line 24: | Line 24: | ||
==Diagnosis== | ==Diagnosis== | ||
*CT | *Imaging<ref>Nussenbaum B et Al. Malignant Otitis Externa Workup. Medscape, Jul 14 2015. http://emedicine.medscape.com/article/845525-workup#c4</ref> | ||
**Most authors support CT initially, but CT fails to dx early osteomyelitis since 30% bone destruction needed for detection | |||
**MRI more sensitive for intracranial complications | |||
*Labs | |||
**WBC usually normal or slightly elevated | |||
**Left shift uncommon | |||
**Elevated ESR differentiates from MOE from acute external otitis or malignancy | |||
==Treatment== | ==Treatment== | ||
Revision as of 17:35, 1 August 2015
Background
- Life-threatening infection of external ear/canal, soft tissue, +/- spread to skull base
- Diabetes and immunosuppression are main risk factors
- Pseudomonas causes >90% of cases
- Begins as simple otitis externa
Clinical Features
Adults
- Otitis externa that has not resolved despite 2-3wks of topical antibiotics
- Otalgia
- Often out of proportion for routine otitis externa
- Edema of external auditory canal
- Granulation tissue often seen in the ear canal floor
- CN IX, X, or XI involvement
- Trismus
Pediatrics
- More rapidly progressive than in adults
- TM, middle ear, and facial nerve more likely to be affected
Differential Diagnosis
Ear Diagnoses
External
- Auricular hematoma
- Auricular perichondritis
- Cholesteatoma
- Contact dermatitis
- Ear foreign body
- Herpes zoster oticus (Ramsay Hunt syndrome)
- Malignant otitis externa
- Otitis externa
- Otomycosis
- Tympanic membrane rupture
Internal
- Acute otitis media
- Chronic otitis media
- Mastoiditis
Inner/vestibular
Diagnosis
- Imaging[1]
- Most authors support CT initially, but CT fails to dx early osteomyelitis since 30% bone destruction needed for detection
- MRI more sensitive for intracranial complications
- Labs
- WBC usually normal or slightly elevated
- Left shift uncommon
- Elevated ESR differentiates from MOE from acute external otitis or malignancy
Treatment
Adults
Peds
Disposition
- Contact ENT for disposition decision; early infection may be managed as outpt
Complications
- Lateral or sigmoid sinus thrombosis
- Meningitis
See Also
Source
- Tintinalli
- ↑ Nussenbaum B et Al. Malignant Otitis Externa Workup. Medscape, Jul 14 2015. http://emedicine.medscape.com/article/845525-workup#c4