Malignant otitis externa: An updated review

Am J Otolaryngol. 2021 Mar-Apr;42(2):102894. doi: 10.1016/j.amjoto.2020.102894. Epub 2021 Jan 5.

Abstract

Malignant otitis externa is a progressive infection of the external auditory canal and skull base. Pseudomonas aeruginosa is the most isolated microorganism and it affects mostly to diabetic, elderly, and immunocompromised individuals. Non-resolving otalgia and chronic otorrhea are the clinical manifestations presented. Facial nerve palsy is a common and well recognized complication. (Computed tomography) CT scan is useful for initial assessment, Technetium-99m is highly sensitive and is part of the protocol for diagnosis. Treatment should be individualized, with multidisciplinary cooperation among specialties. Management involves systemic antipseudomonal antibiotics and monitoring with radiologic techniques, it also involves the strict control of diabetes. It is essential to follow up the patients for at least a year post-treatment. In refractory malignant otitis externa and affection of facial nerve, surgical management is recommended. We reviewed the most recent studies on epidemiology, clinical manifestations, diagnosis, and treatment to provide an update on Malignant Otitis Externa that can offer an overview for clinical practice and future research.

Keywords: Malignant otitis externa; Necrotizing otitis externa; Skull base osteomyelitis.

Publication types

  • Review

MeSH terms

  • Aged
  • Anti-Bacterial Agents / administration & dosage*
  • Diabetes Mellitus
  • Female
  • Follow-Up Studies
  • Humans
  • Immunocompromised Host
  • Male
  • Otitis Externa / diagnostic imaging
  • Otitis Externa / epidemiology
  • Otitis Externa / microbiology*
  • Otitis Externa / therapy*
  • Otologic Surgical Procedures*
  • Pseudomonas Infections*
  • Pseudomonas aeruginosa
  • Severity of Illness Index
  • Skull Base
  • Tomography, X-Ray Computed

Substances

  • Anti-Bacterial Agents