gms | German Medical Science

Objective: Malignant external otitis (MEO) is an invasive infection of the external auditory canal that poses a difficult therapeutic challenge.

Methods: Twelve consecutive patients were hospitalized for suspected MEO between 2009 and 2012 (average age 69 years, age range 49–85; male 7, female 5). All demographic data, underlying diseases, ear parameters, culture findings, computed tomography findings, length of hospitalization, and treatment before hospitalization were analyzed.

Results: The typical patient presents with exquisitely painful and purulent otorrhoea. Facial paralysis was present in 2 cases. The diagnosis of malignant external otitis is based on a combination of clinical findings, an increased erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP), and radiographic evidence of soft tissue with or without bone erosion in the external canal and infratemporal fossa. Treatment consists of local debridement and prolonged administration (3–6 weeks) of an local and systemic antipseudomonal agent. In three cases we make additionally ventilation T-tubes insertion for 3–6 months. One patient undergoing additional surgical treatment (mastoidectomy).

Conclusion: Malignant external otitis is a rare disease, which is best managed in a multidisciplinary team setting. The most effective treatment is to control the diabetes and to fight infection with the proper antibiotic treatment. In our study the association of local aminoglycoside antibiotics and systemic ciprofloxacin and clindamycine was efficient in countering the increasing resistance of P. aeruginosa to quinolones. ESR and CRP combined with appropriate clinical and radiological investigations are useful in assessing disease resolution. In some cases ventilation T-tube insertion for 3–6 months seems to be a good idea for additional minimal invasive surgical treatment.

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