Malignant Otitis Externa

Malignant Otitis Externa

Q. 1

Which of the following is NOT a typical feature of malignant otitis externa?

 A

Caused by Pseudomonas aeruginosa

 B

Patients are usually old

 C

Mitotic figures are high

 D

Patient is immunocompromised

Q. 1

Which of the following is NOT a typical feature of malignant otitis externa?

 A

Caused by Pseudomonas aeruginosa

 B

Patients are usually old

 C

Mitotic figures are high

 D

Patient is immunocompromised

Ans. C

Explanation:

High mitotic figures are suggestive of a malignant pathology. Malignant otitis externa is an infective condition, not a malignant one.


Q. 2

True statement about malignant otitis externa is:

 A

Not painful

 B

Common in diabetics and old age

 C

Caused by streptococcus

 D

All of the above

Q. 2

True statement about malignant otitis externa is:

 A

Not painful

 B

Common in diabetics and old age

 C

Caused by streptococcus

 D

All of the above

Ans. B

Explanation:

Q. 3

Malignant otitis externa is:

 A

Malignancy of external ear

 B

Caused by hemophilus influenzae

 C

Blackish mass of aspergillus

 D

Pseudomonas infection in diabetic patient

Q. 3

Malignant otitis externa is:

 A

Malignancy of external ear

 B

Caused by hemophilus influenzae

 C

Blackish mass of aspergillus

 D

Pseudomonas infection in diabetic patient

Ans. D

Explanation:

Q. 4

Malignant otitis externa is characterized:

 A

Caused by pseudomonas aeruginosa

 B

Malignancy of external auditory canal

 C

Granulation tissue is seen in the floor of external auditory canal

 D

a and c

Q. 4

Malignant otitis externa is characterized:

 A

Caused by pseudomonas aeruginosa

 B

Malignancy of external auditory canal

 C

Granulation tissue is seen in the floor of external auditory canal

 D

a and c

Ans. D

Explanation:

Q. 5

An elderly diabetic presents with painful ear discharge and edema of the external auditory canal with facial palsy, not responding to antibiotics. An increased uptake on technetium bone scan is noted. The most probable diagnosis is

 A

Malignant otitis externa

 B

Malignancy of the middle ear

 C

Infective disease of the middle ear

 D

Malignancy of nasopharynx with Eustachian tube ob­struction

Q. 5

An elderly diabetic presents with painful ear discharge and edema of the external auditory canal with facial palsy, not responding to antibiotics. An increased uptake on technetium bone scan is noted. The most probable diagnosis is

 A

Malignant otitis externa

 B

Malignancy of the middle ear

 C

Infective disease of the middle ear

 D

Malignancy of nasopharynx with Eustachian tube ob­struction

Ans. A

Explanation:

Q. 6

Facial nerve palsy is seen in:

 A

Seborrheic otitis externa 

 B

Otomycosis

 C

Malignant otitis externa 

 D

Eczematous otitis externa

Q. 6

Facial nerve palsy is seen in:

 A

Seborrheic otitis externa 

 B

Otomycosis

 C

Malignant otitis externa 

 D

Eczematous otitis externa

Ans. C

Explanation:

Q. 7

A female diabetic having severe ear pain and granulation tissue in external ear with Facial palsy is due to:

 A

Malignant otitis externa 

 B

Herpes zoster otitis

 C

Otomycosis

 D

None

Q. 7

A female diabetic having severe ear pain and granulation tissue in external ear with Facial palsy is due to:

 A

Malignant otitis externa 

 B

Herpes zoster otitis

 C

Otomycosis

 D

None

Ans. A

Explanation:

 

 Malignant otitis externa – can cause destruction of tissues of canal, pre and post auricular region by various enzymes like leci­thinase and hemolysis.

Infection can spread to skull base and jugular foramen causing multiple cranial nerve palsies in which most common is facial nerve palsy.



Q. 8

Facial nerve palsy is seen in this condition:

 A

Seborrheic otitis externa 

 B

Otomycosis

 C

Malignant otitis externa 

 D

Cerebellar abscess

Q. 8

Facial nerve palsy is seen in this condition:

 A

Seborrheic otitis externa 

 B

Otomycosis

 C

Malignant otitis externa 

 D

Cerebellar abscess

Ans. C

Explanation:

Q. 9

All of the following are true about malignant otitis ex­terna except:

 A

ESR is used for follow up after treatment

 B

Granulation tissues are seen on superior wall of the ex­ternal auditory canal

 C

Severe hearing loss is the chief presenting complaint

 D

Pseudomonas is the most common cause

Q. 9

All of the following are true about malignant otitis ex­terna except:

 A

ESR is used for follow up after treatment

 B

Granulation tissues are seen on superior wall of the ex­ternal auditory canal

 C

Severe hearing loss is the chief presenting complaint

 D

Pseudomonas is the most common cause

Ans. C

Explanation:

 

Severe hearing loss is not the chief presenting complaint in malignant otitis externa.

A patient of malignant otitis externa presents with:

  • Severe, unrelenting, deep-seated otalgia, temporal headaches, purulent otorrhea, possibly dysphagia, hoarseness, and/ or facial nerve dysfunction.
  • The pain is out of proportion to the physical examination findings.
  • Marked tenderness is present in the soft tissue between the mandible ramus and mastoid tip.
  • Granulation tissue is present at the floor of the osseo-cartiliginous junction. This finding is virtually pathognomonic of malignant external otitis.
  • Rest of the options i.e. pseudomonas is the M/C cause, granulation tissue seen on superior wall of the external auditory canal and esr used for follow up are correct.

Q. 10

A 75-year old diabetic patient presents with severe ear pain and granulation tissue at external auditory canal with facial nerve involvement. The most likely diagnosis is:

 A

Malignant otitis externa

 B

Nasopharyngeal carcinoma

 C

Acute suppurative otitis media

 D

Chronic suppurative otitis media

Q. 10

A 75-year old diabetic patient presents with severe ear pain and granulation tissue at external auditory canal with facial nerve involvement. The most likely diagnosis is:

 A

Malignant otitis externa

 B

Nasopharyngeal carcinoma

 C

Acute suppurative otitis media

 D

Chronic suppurative otitis media

Ans. A

Explanation:

Q. 11

Life threatening complications of diabetes mellitus are all except:

 A

Malignant otitis externa

 B

Rhinocerebral mucormycosis

 C

Emphesematous pyelonephritis

 D

Emphysematous appendicitis

Q. 11

Life threatening complications of diabetes mellitus are all except:

 A

Malignant otitis externa

 B

Rhinocerebral mucormycosis

 C

Emphesematous pyelonephritis

 D

Emphysematous appendicitis

Ans. D

Explanation:

Answer is D (Emphysematous Appendicitis):

Emphysematous Appendicitis has not been listed as a fatal complication of diabetes mellitus.

Malignant Otitis Externa is a potential life threatening complication of Diabetes

‘Invasive otitis externa, also known as malignant otitis externa or necrotizing otitis externa is an aggressive and life threatening disease that occurs predominantly in elderly diabetics and other immunocompromised patients’

Rhinocereberal Mucormycosis is a potential life threatening complication of Diabetes

‘Rhinocerebral mucormycosis is an invasive life threatening fungal infection that usually develops in diabetic patients and immunocompromised patients’ – Harrison 16th/186

Emphysematous Pyelonephritis is a potential life threatening complication of Diabetes

Emphysematous pyelonephritis is usually characterized by rapidly progressive clinical course, with accumulation of fermentative gases in the kidney and perinephritic tissues. This condition almost always occurs in diabetic patients and surgical resection of the involved tissue and antimicrobial therapy is usually needed to prevent a fatal outcome-Harrison 16th/1720


Q. 12

Malignant otitis externa is caused by:   

 A

S.aureus

 B

S. albus

 C

P. aeruginosa

 D

E. coli

Q. 12

Malignant otitis externa is caused by:   

 A

S.aureus

 B

S. albus

 C

P. aeruginosa

 D

E. coli

Ans. C

Explanation:

 

Malignant (necrotising) otitis externa is an inflammatory condition caused by pseudomonas infection

Necrotizing external otitis (malignant otitis externa)

  • It is an uncommon form of external otitis occurs mainly in elderly diabetics.
  • It can develop due to a severely compromised immune system.
  • Beginning as infection of the external ear canal, there is extension of infection into the bony ear canal and the soft tissues deep to the bony canal.

The hallmark of malignant otitis externa (MOE) is unrelenting pain that interferes with sleep and persists even after swelling of the external ear canal may have resolved with topical antibiotic treatment.

Natural history

  • MOE follows a much more chronic and indolent course than ordinary acute otitis externa.
  • There may be granulation involving the floor of the external ear canal, most often at the bony-cartilaginous junction.
  • Paradoxically, the physical findings of MOE, at least in its early stages, are often much less dramatic than those of ordinary acute otitis externa.
  • In later stages there can be soft tissue swelling around the ear, even in the absence of significant canal swelling. While fever and leukocytosis might be expected in response to bacterial infection invading the skull region, MOE does not cause fever or elevation of white blood count.

Treatment of MOE

  • Unlike ordinary otitis externa, MOE requires oral or intravenous antibiotics for cure.
  • Diabetes control is also an essential part of treatment.
  • When MOE goes unrecognized and untreated, the infection continues to smolder and over weeks or months can spread deeper into the head and involve the bones of the skull base, constituting skull base osteomyelitis (SBO). The infecting organism is almost always pseudomonas aeruginosa, but it can instead be fungal (aspergillus or mucor).
  • MOE and SBO are not amenable to surgery, but exploratory surgery may facilitate culture of unusual organism(s) that are not responding to empirically used anti-pseudomonal antibiotics.
  • The usual surgical finding is diffuse cellulitis without localized abscess formation. SBO can extend into the petrous apex of the temporal bone or more inferiorly into the opposite side of the skull base.

Complications

  • As the skull base is progressively involved, the adjacent exiting cranial nerves and their branches, especially the
    facial nerve and the vagus nerve, may be affected, resulting in facial paralysis and hoarseness, respectively.
  • If both of the recurrent laryngeal nerves are paralyzed, shortness of breath may develop and necessitate tracheotomy.
  • Profound deafness can occur, usually later in the disease course due to relative resistance of the inner ear structures

Q. 13

In malignant otitis externa which nerve commonly affected ‑

 A

Abducent

 B

Facial

 C

Auditory

 D

Vagus

Q. 13

In malignant otitis externa which nerve commonly affected ‑

 A

Abducent

 B

Facial

 C

Auditory

 D

Vagus

Ans. B

Explanation:

 

Most commonly facial nerve is involved. Other cranial nerves can also be involved (glossopharyngeal, vagus, spinal accessory, hypoglossal, abducens, trigeminal).


Q. 14

Mailgnant otitis externa is due to ‑

 A

Wax impaction

 B

Hypertesion

 C

Diabetes

 D

None of above

Q. 14

Mailgnant otitis externa is due to ‑

 A

Wax impaction

 B

Hypertesion

 C

Diabetes

 D

None of above

Ans. C

Explanation:


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