Malignant otitis externa: Difference between revisions
m (Rossdonaldson1 moved page Malignant Otitis Externa to Malignant otitis externa) |
|||
| Line 6: | Line 6: | ||
==Clinical Features== | ==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 | ||
**[[Fever]], leukocytosis, bacteremia/[[sepsis]] | |||
*TM, middle ear, and facial nerve more likely to be affected | |||
==Differential Diagnosis== | |||
{{Ear DDX}} | |||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 22:11, 1 March 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
- CT
Treatment
- Adults
- Antipseudomonal cephalosporin OR fluoroquinolone
- 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
