Malignant Otitis Externa
Infection Malignant otitis externa Brief outline/clinical setting Malignant otitis externa ( is also known as necrotizing otitis externa. MOE is an invasive infection of the external auditory canal and the skull base. This infection typically occurs in elderly patients with diabetes mellitus. MOE is being increasingly reported in patients who are immunocompromised (including HIV). Clinical featur
| Infection | Malignant otitis externa |
|---|---|
| Brief outline/clinical setting | Malignant otitis externa ( is also known as necrotizing otitis externa. MOE is an invasive infection of the external auditory canal and the skull base. This infection typically occurs in elderly patients with diabetes mellitus. MOE is being increasingly reported in patients who are immunocompromised (including HIV). Clinical features include severe otalgia (often nocturnal and extending into the temporomandibular joint, resulting in pain on chewing) and otorrhoea. Granulation tissue is frequently visible in the inferior portion of the external auditory canal. In advanced infections osteomyelitis of the base of skull and temporomandibular joint may develop. |
| Aetiologies/organisms | Pseudomonas aeruginosa - 95% cases Other Aspergillus species, Staphylococcus aureus, Proteus mirabilis, Klebsiella oxytoca, Candida species |
| Optimal antimicrobial selection |
Immunocompetent patients with uncomplicated MOE: Critical to have culture and sensitivity: pre onset of therapy as may o f the above organisms would not respond to ciprofloxacin if this is the only oral agent available that would prevent hospitalisation Repeat biopsy for culture and susceptibility if failure to improve Advanced MOE Discuss with ENT Dual quinolone (ciprofloxacin and antipseudomonal antimicrobial Anti-pseudomonal antimicrobial options: 3. Piperacillin – tazobactam – 4.5gm iv 6 hourly 4. Ceftazidime – 2 gm iv 8 hourly Can change to ciprofloxacin oral monotherapy following clinical improvement. |
| Duration | 6-8 weeks |
| Alternative if allergic/not available | |
| Rationale | |
| Level of evidence | |
| Link to Guideline |