Increasing burden of necrotizing otitis externa: our experience of 38 cases
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20211581Keywords:
Malignant otitis externa, Skull base osteomyelitis, Ciprofloxacin, Ceftazidime, PseudomonasAbstract
Background: Necrotizing otitis externa is an infection affecting immune-compromised and elderly diabetic patients resulting in complications with significant morbidity and mortality. We present our experience with this disease, along with the investigative tools and treatment modalities that benefitted most. The objective being to analyze the course of the disease and the benefit of having an institutional protocol for its management.
Methods: This is a retrospective observational study on patients diagnosed with necrotizing otitis externa between 2013-2019.
Results: Out of 38 patients 36 were diabetics, the commonest clinical presentation included otalgia in 37 patients, granulations in 35, facial nerve palsy in 14 and Pseudomonas aeruginosa was isolated in 19 patients. They were managed with multidrug combination antibiotic therapy, topical dressing and drops with 27 showing improvement.
Conclusions: We recommend a diagnostic triad for NOE comprising of otalgia in an elderly diabetic patient with granulations in the external auditory canal. It is best managed by controlling diabetes, appropriate antibiotic combination, topical dressing, and sometimes surgical debridement.
References
Chandler JR. Malignant external otitis. Laryngoscope. 1968;78:1257-94.
Slattery WH, Brackmann DE. Skull-base osteomyelitis. Malignant external otitis. Otolaryngol Clin North Am. 1996;29:795-806.
Lucente FE, Parisier SC, Som PM, Arnold LM. Malignant external Otitis: a dangerous misnomer? Otolaryngol Head Neck Surg. 1982;90:266-9.
Gates GA, Montalbo PJ, Meyerhoff WL. Pseudomonas Mastoiditis. Laryngoscope. 1977;87: 483-92.
Lambor DV, Das CP, Goel HC, Tiwari M, Lambor SD, Fegade MV. Necrotising otitis externa: clinical profile and management protocol. J Laryngol Otol. 2013;127(11):1071-7.
Cohen D, Freidman P. The diagnostic criteria of malignant external otitis. J Laryngol Otol. 1987; 101:216-21.
Karaman E, Yilmaz M, Ibrahimov M, Haciyev Y, Enver O. Malignant otitis externa. J Craniofac Surg. 2012;23(6):1748-51.
Chandler JR. Pathogenesis and treatment of facial paralysis due to malignant external otitis. Ann Otol Rhinol Laryngol. 1972;81:648-58.
John AC, Hopkins HB. An unusual case of necrotizing otitis externa. J Laryngol Otol. 1978; 92:811-12.
Shpitzer T, Stern Y. Malignant external otitis in nondiabetic patients. Ann Otol Rhinol Laryngol. 1993;102:870-2.
Bains SH, Gurdeep D. Malignant otitis externa. Indian Pediatr. 2010;47:195-6.
Nir D, Nir T, Danino J, Joachims HZ. Malignant external otitis in an infant. J Laryngol Otol. 1990; 04(6):488-90.
Osama ES, Sharnuby M. Malignant otitis: management policy. J Laryngol Otol. 1992;106:5-6.
Ali T, Meade K, Anari S, Elbadawey MR, Zammit-Maempel I. Malignant external otitis: case series. J Laryngol Otol. 2010;124:846-51.
Driscoll PV, Ramachandrula A, Drezner DA, Hicks TA, Schaffer SR. Characteristics of cerumen in diabetic patients: a key to understanding malignant external otitis?. Otolaryngol Head Neck Surg. 1993; 109:676-9.
Corey JP, Levandowski RA, Panwalker AP. Prognostic implications of therapy for necrotizing external otitis. Am J Otolaryngol. 1985;6:353-8.
Gordon G, Giddings L. Invasive otitis externa due to aspergillus species: case report and review. Arch Clin Infect. 1994;19(5):866-70.
Scott-Brown. Otorhinolaryngology, head and neck Surgery. 7th ed. Great Britain: Hodder Arnold; 2008.
Bhat V, Aziz A, Satheesh KB, Rajeshwary A, Shrinath D. Malignant otitis externa - a retrospective study of 15 patients treated in a tertiary healthcare center. Int Adv Otol. 2005;11(1):72-6.
El-Silimy O, Sharnuby M. Malignant external otitis: management policy. J Laryngol Otol. 1992;49:408-11.
Uri N, Gips S, Front A, Meyer SW, Hardoff R. Quantitative bone and 67Ga scintigraphy in the differentiation of necrotizing external otitis from severe external otitis. Arch. 1991;117:623-6.
Lucente F, Parisier S, Som P. Complications of treatment of malignant external otitis. Laryngoscope. 1983;93:279-81.
Schweitzer VG. Hyperbaric oxygen management of chronic staphylococcal osteomyelitis of the temporal bone. Am J Otolaryngol. 1990;11:347-53.
Shupak A, Greenberg E, Hardoff R, Gordon C. Hyperbaric oxygenation for necrotizing(malignant) otitis externa. Arch Otolaryngol Head Neck Surg. 1989;115:1470-5.
Mader JT, Love JT. Malignant external otitis. Cure with adjunctive hyperbaric oxygen therapy. Arch Otolaryngol Head Neck Surg. 1982;108:38-40.
Davis JC, Gates GA, Lerner C, Davis MG. Adjuvant hyperbaric oxygen in malignant external otitis. Arch Otolaryngol Head Neck Surg. 1992;118:89-93.
Rubin J, Yu VL. Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis and therapy. Am J Med. 1988;85:391-8.
Amrosa L, Modugno GC, Pirodda A. Malignant external otitis: review and personal experience. Acta Oto-Laryngologica Supplement. 1996;521:3-16.
Weir N, Kenyon G, Jones N. Scott Brown's Otolaryngology. 6th ed. London: Cambridge University Press; 1998.
Kimmelman CP, Lucente FE. Use of ceftazidime for malignant external otitis. Ann Otol Rhinol Laryngol. 1989;98(9):721-5.
Holten KB, Gick J. Management of the patient with otitis externa. J Fam Pract. 2001;50:353-60.
Franco-Vidal V, Blanchet H, Bebear C, Dutronc H, Darrouzet V. Necrotising external otitis: a report of 46 cases. Otol Neurotol. 2007;28:771-3.
Kaya İ, Sezgin B, Eraslan S. Malignant otitis externa: a retrospective analysis and treatment outcomes. Turk Arch Otorhinolaryngol. 2018;56(2): 106-10.
Hariga I, Mardassi A, Belhaj Younes F, Ben Amor M. Necrotizing otitis externa: 19 cases’ report. Eur Arch Otorhinolaryngol. 2010;267(8):1193-8.
Soheilipour S, Meidani M, Derakhshandi H, Etemadifar M. Necrotizing external otitis: a case series. B-ENT. 2013;9(1):61-6.
Slattery WH, Brackmann DE. Skull base osteomyelitis. Malignant external otitis. Otolaryngol Clin North Am. 1996;29:795-806.
Chandler JR. Malignant external otitis and osteomyelitis of the base of the skull. Am J Otol 1989;10:108-10.
Levenson MJ, Parisier SC, Dolitsky J, Bindra G. Ciprofloxacin: drug of choice in the treatment of malignant external otitis. Laryngoscope. 1991;101: 821-4.
Loh S, Loh WS. Malignant otitis externa. Otolaryngol Head Neck Surg. 2013;148(6):991-6.
O’Sullivan TJ, Dickson RI, Blockmanis A, Roberts FJ, Kaan K. The pathogenesis, differential diagnosis, and treatment of malignant otitis externa. J Otolaryngol. 1978;7:297-303.
Berenholz L, Katzenell U, Harell M. Evolving resistant pseudomonas to ciprofloxacin in malignant otitis externa. Laryngoscope. 2002;112:1619-22.
Kraus DH, Rehm S, Kinney SE. The evolving treatment of necrotizing external otitis. Laryngoscope. 1988;98:934-9.
Joaquim HZ, Danino J, Raj R. Malignant external otitis: treatment with fluoroquinolones. Am J Otolaryngol. 1988;9:102-5.
Hickey SA, Ford GR, Fitzgerald AF. Treating malignant otitis externa with oral ciprofloxacin. BMJ. 1989;298:550-1.
Kimmelman CP, Lucente F. Use of ceftazidime for malignant external otitis. Ann Otol Rhinol Laryngol 1989;98:721-5.
Johnson MP, Ramphal R. Malignant external otitis: report on therapy with ceftazidime and review of therapy and prognosis. Rev Infect Dis. 1990;12:173-80.
Gruber M, Sela E, Doweck I, Roitman A. The role of surgery in necrotizing otitis externa. Ear Nose Throat J. 2017;96(1):E16-21.
