Malignant Otitis Externa

MALIGNANT OTITIS EXTERNA

•  Necrotizing otitis externa or skull base osteomyelitis
• Caused by Pseudomonas aeruginosa infection
• Diabetes is the major predisposing factor
• Can occur in Immuno-compromised Patients
•  Severe pain worsening at night
• Presence of granulations at bony cartilaginous junction (Also in Floor of External Auditory Canal)
•  Biopsy and radical surgery to be avoided
•  Multiple cranial nerve palsies can occur – Most Common – Facial Nerve Palsy
• Infection may spread to the skull base and jugular foramen causing multiple cranial nerve palsies.
• Anteriorly, infection spreads to temporomandibular fossa,
• Posteriorly to the mastoid and medially into the middle ear and petrous bone.
• Most common nerve palsy – facial nerve
• Gallium-67 scan is useful in diagnosis and follow-up
• Treatment: diabetes control, antibiotics, surgery (drainage of subperiosteal abscess, removal of necrotic tissue and sequestrated bone)