Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-03T09:11:38.772Z Has data issue: false hasContentIssue false

Necrotising otitis externa: clinical profile and management protocol

Published online by Cambridge University Press:  29 October 2013

D V Lambor*
Affiliation:
Department of Ear, Nose, Throat and Head and Neck Surgery, Goa Medical College and Hospital, India
C P Das
Affiliation:
Department of Ear, Nose, Throat and Head and Neck Surgery, Goa Medical College and Hospital, India
H C Goel
Affiliation:
Department of Ear, Nose, Throat and Head and Neck Surgery, Goa Medical College and Hospital, India
M Tiwari
Affiliation:
Department of Ear, Nose, Throat and Head and Neck Surgery, Goa Medical College and Hospital, India
S D Lambor
Affiliation:
Department of Ear, Nose, Throat and Head and Neck Surgery, Goa Medical College and Hospital, India
M V Fegade
Affiliation:
Department of Pharmacology, Goa Medical College and Hospital, India
*
Address for correspondence: Dr D V Lambor, Department of ENT, Goa Medical College, Bambolim, Goa, India-403202 E-mail: [email protected]

Abstract

Background:

Necrotising otitis externa, which is typically seen in elderly diabetics, is a severe infective disorder caused by Pseudomonas aeruginosa. There is lack of standard management policy for necrotising otitis externa, hence this study attempted to frame a protocol for management based on clinical parameters.

Method:

A retrospective study of 27 patients with necrotising otitis externa was conducted over 6 years in a tertiary care hospital. Data were analysed with regards to demographic characteristics, clinical features, investigations, staging and treatment modalities.

Results:

Out of 27 patients, 26 were diabetics. The commonest organism isolated was P aeruginosa, which was sensitive to third generation cephalosporins and fluoroquinolones. Nine patients had cranial nerve involvement. Twelve of 15 patients treated with medical therapy recovered, as did 11 of 12 patients that underwent surgery.

Conclusion:

A high index of suspicion, early diagnosis and prompt intervention are key factors to decrease morbidity and mortality. Fluoroquinolones, third generation cephalosporins and surgical debridement are the mainstay of treatment.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Toulmouche, MA. Observations on cerebral otorrhoea: further deliberations [in French]. Gaz Med Paris 1838;6:422–6Google Scholar
2Meltzer, PE, Keleman, G. Pyocyaneus osteomyelitis of the temporal bone, mandible and zygoma. Laryngoscope 1959;69:1300–16CrossRefGoogle Scholar
3Chandler, JR. Malignant external otitis. Laryngoscope 1968;78:1257–94CrossRefGoogle ScholarPubMed
4Gates, GA, Montalbo, PJ, Meyerhoff, WL. Pseudomonas mastoiditis. Laryngoscope 1977;87:483–92Google Scholar
5Cohen, D, Freidman, P. The diagnostic criteria of malignant external otitis. J Laryngol Otol 1987;101:216–21CrossRefGoogle ScholarPubMed
6Chandler, JR. Pathogenesis and treatment of facial paralysis due to malignant external otitis. Ann Otol Rhinol Laryngol 1972;81:648–58CrossRefGoogle ScholarPubMed
7John, AC, Hopkins, HB. An unusual case of necrotizing otitis externa. J Laryngol Otol 1978;92:811–12CrossRefGoogle ScholarPubMed
8Shpitzer, T, Stern, Y. Malignant external otitis in nondiabetic patients. Ann Otol Rhinol Laryngol 1993;102:870–2CrossRefGoogle ScholarPubMed
9Soliman, AE. A rare case of malignant otitis externa in a nondiabetic patient. J Laryngol Otol 1978;92:811–12CrossRefGoogle Scholar
10Shamboul, L, Burns, H. Malignant external otitis in a young diabetic patient. J Laryngol Otol 1983;97:247–9CrossRefGoogle Scholar
11Rubinstein, E, Ostfeld, E. Necrotizing external otitis. Pediatrics 1980;66:618–20CrossRefGoogle ScholarPubMed
12Joachims, HZ. Malignant external otitis in children. Arch Otolaryngol 1976;102:236–7CrossRefGoogle ScholarPubMed
13Bagdade, JD, Root, RK, Bulger, RJ. Impaired leucocyte function in patients with poorly controlled diabetes. Diabetes 1974;23:915CrossRefGoogle ScholarPubMed
14Eliashiv, A, Olumide, F, Norton, L, Eiseman, B. Depression of cell-mediated immunity in diabetes. Arch Surg 1978;113:1180–3CrossRefGoogle ScholarPubMed
15Mowat, AC, Baum, J. Chemotaxis of polymorphonuclear leucocytes from patients with diabetes mellitus. N Engl J Med 1971;284:621–7CrossRefGoogle ScholarPubMed
16Driscoll, PV, Ramachandrula, A, Drezner, DA, Hicks, TA, Schaffer, SR. Characteristics of cerumen in diabetes patients: a key to understanding malignant external otitis? Otolaryngol Head Neck Surg 1993;109:676–9CrossRefGoogle ScholarPubMed
17Barrow, HN, Levenson, MJ. Necrotising ‘malignant’ external otitis caused by Staphylococcus epidermidis. Arch Otolaryngol Head Neck Surg 1992;118:94–6CrossRefGoogle ScholarPubMed
18Keay, DG, Murray, JA. Malignant otitis externa due to Staphylococcus infection. J Laryngol Otol 1988;102:926–7CrossRefGoogle ScholarPubMed
19Senegor, M, Lewis, HP. Salmonella osteomyelitis of the skull base. Surg Neurol 1991;36:37–9CrossRefGoogle ScholarPubMed
20Cunningham, M, Yu, VL, Turner, J, Curtin, H. Necrotising otitis externa due to Aspergillus in an immunocompetent patient. Arch Otolaryngol Head Neck Surg 1988;114:554–6CrossRefGoogle Scholar
21Menachof, MR, Jackler, RK. Otogenic skull base osteomyelitis caused by invasive fungal infection. Otolaryngol Head Neck Surg 1990;102:285–9CrossRefGoogle ScholarPubMed
22Kountakis, SE, Kemper, JV Jr, Chang, CY, DiMaio, DJ, Stiernberg, CM. Osteomyelitis of the base of the skull secondary to Aspergillus. Am J Otolaryngol 1997;18:1922CrossRefGoogle ScholarPubMed
23Stodulski, D, Kowalska, B, Stankiewicz, C. Otogenic skull base osteomyelitis caused by invasive fungal infection: case report and literature review. Eur Arch Otorhinolaryngol 2006;263:1070–6CrossRefGoogle ScholarPubMed
24Lucente, F, Parisier, S, Som, P. Complications of treatment of malignant external otitis. Laryngoscope 1983;93:279–81CrossRefGoogle ScholarPubMed
25Slattery, WH, Brackmann, DE. Skull base osteomyelitis. Malignant external otitis. Otolaryngol Clin North Am 1996;29:795806CrossRefGoogle ScholarPubMed
26Scully, BE, Neu, HC, Parry, MF. Oral ciprofloxacin therapy of infection due to Pseudomonas aeruginosa. Lancet 1986;1:819–22CrossRefGoogle Scholar
27Leggett, JM, Prendergast, K. Malignant external otitis: the use of oral ciprofloxacin. J Laryngol Otol 1988;102:53–4CrossRefGoogle ScholarPubMed
28Davis, JC, Gates, GA, Lerner, C, Davis, MG Jr, Mader, JT, Dinesman, A. Adjuvant hyperbaric oxygen in malignant external otitis. Arch Otolaryngol Head Neck Surg 1992;118:8993CrossRefGoogle ScholarPubMed
29Gleeson, MJ, ed. Scott-Brown's Otorhinolaryngology, Head and Neck Surgery, 7th edn, vol 3. London: Hodder Arnold, 3336–9Google Scholar
30Doroghazi, RM, Nadol, JB, Hyslop, NE, Baker, AS, Axelrod, L. Invasive external otitis. Report of 21 cases and review of literature. Am J Med 1981;71:603–14CrossRefGoogle Scholar
31Osama, ES, Sharnuby, M. Malignant external otitis: management policy. J Laryngol Otol 1992;106:56Google Scholar
32Ali, T, Meade, K, Anari, S, Elbadawey, MR, Zammit-Maempel, I. Malignant external otitis: case series. J Laryngol Otol 2010;124:846–51CrossRefGoogle ScholarPubMed
33Amorosa, L, Modugno, GC, Piroda, A. Malignant external otitis: review and personal experience. Acta Otolaryngol 1996;521:316CrossRefGoogle ScholarPubMed
34Franco-Vidal, V, Blanchet, H, Bebear, C, Dutronc, H, Darrouzet, V. Necrotising external otitis: a report of 46 cases. Otol Neurotol 2007;28:771–3CrossRefGoogle Scholar
35Rubin, J, Yu, VL. Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis, and therapy. Am J Med 1988;85:391–8CrossRefGoogle ScholarPubMed
36Ennouri, A, Ben Abdallah, N, Bouzouita, K, Marrakchi, H, Atallah, M. Malignant external otitis in diabetics. Rev Laryngol Otol Rhinol (Bord) 1989;110:912Google ScholarPubMed
37Corey, JP, Levandowski, RA, Panwalker, AP. Prognostic implications of therapy for necrotizing external otitis. Am J Otol 1985;6:353–8Google ScholarPubMed
38Chandler, JR. Malignant external otitis and osteomyelitis of the base of the skull. Am J Otol 1989;10:108–10Google ScholarPubMed
39Levenson, MJ, Parisier, SC, Dolitsky, J, Bindra, G. Ciprofloxacin: drug of choice in the treatment of malignant external otitis. Laryngoscope 1991;101:821–4CrossRefGoogle ScholarPubMed
40Chandler, JR. Malignant external otitis and facial paralysis. Otolaryngol Clin North Am 1974;7:375–83CrossRefGoogle ScholarPubMed
41Carfare, MJ, Kesser, BW. Malignant otitis externa. Otolaryngol Clin North Am 2008;41:537–49CrossRefGoogle Scholar
42Rubin Grandis, J, Branstetter, BF 4th, Yu, VL. The changing face of malignant (necrotising) external otitis: clinical, radiological and anatomic correlations. Lancet Infect Dis 2004;4:34–9CrossRefGoogle ScholarPubMed
43Soudry, E, Joshua, BZ, Sulkes, J, Nageris, BI. Characteristics and prognosis of malignant external otitis with facial paralysis. Arch Otolaryngol Head Neck Surg 2007;133:1002–4CrossRefGoogle ScholarPubMed
44O'Sullivan, TJ, Dickson, RI, Blockmanis, A, Roberts, FJ, Kaan, K. The pathogenesis, differential diagnosis, and treatment of malignant otitis externa. J Otolaryngol 1978;7:297303Google ScholarPubMed
45Berenholz, L, Katzenell, U, Harell, M. Evolving resistant pseudomonas to ciprofloxacin in malignant otitis externa. Laryngoscope 2002;112:1619–22CrossRefGoogle ScholarPubMed
46Kraus, DH, Rehm, S, Kinney, SE. The evolving treatment of necrotizing external otitis. Laryngoscope 1988;98:934–9CrossRefGoogle ScholarPubMed
47Benecke, JE. Management of osteomyelitis of the skull base. Laryngoscope 1989;99:1220–3CrossRefGoogle ScholarPubMed
48Kimmelman, CP, Lucente, F. Use of ceftazidime for malignant external otitis. Ann Otol Rhinol Laryngol 1989;98:721–5CrossRefGoogle ScholarPubMed
49Johnson M, P, Ramphal, R. Malignant external otitis: report on therapy with ceftazidime and review of therapy and prognosis. Rev Infect Dis 1990;12:173–80CrossRefGoogle Scholar
50Sade, J, Lang, R, Goshen, S, Kitzes-Cohen, R. Ciprofloxacin treatment of malignant external otitis. Am J Med 1989;87:138–41CrossRefGoogle ScholarPubMed
51Hickey, SA, Ford, GR, Fitzgerald, AF, O'Connor, Eykyn, SJ, Sonksen, PH. Treating malignant otitis externa with oral ciprofloxacin. BMJ 1989;298:550–1CrossRefGoogle Scholar