Malignant otitis externa

Revision as of 22:10, 1 March 2015 by Rossdonaldson1 (talk | contribs) (Rossdonaldson1 moved page Malignant Otitis Externa to 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 fluoroquinolone
  • Peds
    • Imipenem OR (aminoglycoside + antipseudomonal penicillin)

Disposition

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

Complications

  1. Lateral or sigmoid sinus thrombosis
  2. Meningitis

See Also

Source

  • Tintinalli