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
- More rapidly progressive than in adults
Diagnosis
- CT
Treatment
- Adults
- Antipseudomonal cephalosporin OR fluoroquinolone
- Peds
- Imipenem OR (aminoglycoside + antipseudomonal penicillin)
Disposition
- Contact ENT for disposition decision; early infection may be managed as outpt
Complications
- Lateral or sigmoid sinus thrombosis
- Meningitis
See Also
Source
- Tintinalli