Malignant (Necrotizing) Otitis Externa
Malignant or necrotizing otitis externa is a rare, invasive infection that begins in the external ear canal and spreads to adjacent tissue. Severe infection may extend to the base of the skull or intra-cranially. Medical knowledge of malignant otitis exte
- PDF / 124,766 Bytes
- 7 Pages / 439.37 x 666.14 pts Page_size
- 31 Downloads / 214 Views
Malignant (Necrotizing) Otitis Externa J. Stone Doggett and Brian Wong
Précis Malignant (Necrotizing) Otitis Externa 1. Clinical Setting: A patient with diabetes mellitus who has ear pain, often severe, and drainage from the external ear canal, often associated with headache or pain in the temperomandibular joint. 2. Diagnosis: (a) History: Almost all patients with malignant otitis externa are diabetics. Ear pain and otorrhea occur in 90 % of patients. Systemic signs of infection such as fever and altered mental other state are uncommon. The facial nerve is the most commonly affected, but cranial nerves may be involved as well. (b) Imaging: Both CT and MRI are recommended. CT is better at detecting early cortical bone erosion, and MRI is better at detecting medullary changes in bone, and thickening of the Dura. (c) Biopsy: Biopsy is required to differentiate infection from malignancy in some cases. 3. Management: After biopsy has been taken, empiric therapy is started with an antibiotic that has anti-pseudomonal and anti-staphylococcal activity. Candidates include cefepime, piperacillin-tazobactam, or an anti-pseudomonal carbapenem. Antibiotics can be narrowed in scope as specific organisms are identified. Surgical debridement is now reserved for cases in which there are abscesses or bony sequestration. Early surgical consultation for biopsy and to assess the need for debridement is mandatory. J.S. Doggett, M.D. • B. Wong, M.D. (*) Division of Infectious Disease, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd (NRC3), Portland, OR 97236, USA e-mail: [email protected] L. Loriaux (ed.), Endocrine Emergencies: Recognition and Treatment, Contemporary Endocrinology 74, DOI 10.1007/978-1-62703-697-9_5, © Springer Science+Business Media New York 2014
49
50
J.S. Doggett and B. Wong
Malignant (Necrotizing) Otitis Externa Malignant or necrotizing otitis externa is a rare, invasive infection that begins in the external ear canal and spreads to adjacent tissue. Severe infection may extend to the base of the skull or intra-cranially. Medical knowledge of malignant otitis externa is primarily derived from retrospective case series. The majority of reported patients are elderly diabetics infected with Pseudomonas aeruginosa. Patients typically present with otalgia and otorrhea with little evidence of systemic illness. Diagnosis is based on clinical presentation, radiographic imaging with CT or MRI, and tissue histology and culture. Treatment requires prolonged systemic antibiotics and surgery is not required for cure in most cases. Mortality for malignant otitis externa has improved since the disease was first characterized, but a significant number of patients have recurrent disease and require multiple courses of antibiotics. Clinicians should suspect malignant otitis externa in diabetic patients who present with symptoms of otitis externa.
Diabetic Susceptibility Chandler coined the term “malignant external otitis” in 1968 when he described a series of 13 patients with severe invasive Pseudomonal infect
Data Loading...
