Malignant Otitis Externa

Malignant otitis externa is a rare extension of otitis externa to surrounding tissues and is most commonly seen in diabetics and other immunocompromised patients.

Causes

Swimmer's ear is fairly most common. It consists of inflammation, irritation, or infection of the outer ear and ear canal. Swimming in polluted water is one way to contract swimmer's ear. Moisture predisposes the ear to infection from water loving bacteria such as Pseudomonas. Other bacteria, or rarely, fungus, can also cause infection. Swimming is not the only cause, but the condition can be caused by scratching the ear.

Chronic swimmer's ear may result from inadequate treatment, or may suggest the presence of a disease in underlying bone, a complication called malignant otitis externa.

Symptoms

• Severe unrelenting pain +++++
• Discharge ++++
• Prior history of otitis externa
• Fever and trismus (less common)

Signs

• Erythema and edema of the pinna and periauricular tissues.
• Exacerbation of pain with movement of the pinna
• Cranial nerve palsies (most frequently VII) in advanced cases ++

Treatment

The main goal of this treatment to cure the infection, usually with ear drops that containing antibiotics. You can also use other treatment such as corticosteroids to reduce itching and inflammation. Sometimes other remedies such as acetic acid drops may also be used.

If the ear canal is very swollen, then you should used wick to plac in the ear, because it help to allow the drops to travel to the end of the canal. Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) may help relieve pain.

In elderly individuals or diabetics with persistent ear pain or drainage, malignant otitis externa is a possibility. The ears should be evaluated with CT scanning to look for bone erosion. Malignant otitis externa is treated with high-dose intravenous antibiotics effective against Pseudomonas aeruginosa.