Malignant otitis externa: Difference between revisions
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**Imipenem OR | **Imipenem OR | ||
**Aminoglycoside + antipseudomonal penicillin | **Aminoglycoside + antipseudomonal penicillin | ||
==Disposition== | |||
#Contact ENT for disposition decision; early infection may be managed as outpt | |||
==Complications== | ==Complications== | ||
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*[[Otitis Externa]] | *[[Otitis Externa]] | ||
*[[Otitis Media (Peds)]] | *[[Otitis Media (Peds)]] | ||
==Source== | ==Source== | ||
*Tintinalli | *Tintinalli | ||
[[Category:ENT]] | |||
[[Category:ID]] | |||
Revision as of 10:58, 19 December 2011
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
- Peds
- More rapidly progressive than in adults
- Fever, leukocytosis, bacteremia/sepsis
- TM, middle ear, and facial nerve more likely to be affected
- More rapidly progressive than in adults
Diagnosis
- CT
Treatment
- Adults
- Antipseudomonal cephalosporin OR
- Fluorouinolone
- Peds
- Imipenem OR
- Aminoglycoside + antipseudomonal penicillin
Disposition
- Contact ENT for disposition decision; early infection may be managed as outpt
Complications
- Lateral or sigmoid sinus thrombosis
- Meningitis
See Also
Source
- Tintinalli