Malignant otitis externa

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

Diagnosis

• CT

Treatment

• Adults
  • Antipseudomonal cephalosporin OR
  • Fluorouinolone
• Peds
  • Imipenem OR
  • Aminoglycoside + antipseudomonal penicillin

Complications

1. Lateral or sigmoid sinus thrombosis
2. Meningitis

Disposition

1. Contact ENT for disposition decision; early infection may be managed as outpt

Source

• Tintinalli