The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations

Lancet Infect Dis. 2004 Jan;4(1):34-9. doi: 10.1016/s1473-3099(03)00858-2.

Abstract

Malignant (necrotising) external otitis is an invasive infection of the external auditory canal. Although elderly patients with diabetes remain the population most commonly affected, immunosuppressed individuals (eg, from HIV infection, chemotherapy, etc) are also susceptible to malignant external otitis. Pseudomonas aeruginosa is isolated from the aural drainage in more than 90% of cases. The pathophysiology is incompletely understood although aural water exposure (eg, irrigation for cerumen impaction) has been reported as a potential iatrogenic factor. The typical patient presents with exquisitely painful otorrhoea. If untreated, cranial neuropathies (most commonly of the facial nerve) can develop due to subtemporal extension of the infection. The diagnosis of malignant external otitis is based on a combination of clinical findings, an increased erythrocyte sedimentation rate, and radiographic evidence of soft tissue with or without bone erosion in the external canal and infratemporal fossa. Treatment consists of prolonged administration (6-8 weeks) of an antipseudomonal agent (typically an orally administered quinolone). With the introduction and widespread use of both oral and topical quinolones, there are reports of less severe presentation of malignant external otitis and even the emergence of ciprofloxacin resistance. Reservation of systemic quinolones for the treatment of invasive ear infections is recommended.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Aged
  • Blood Sedimentation
  • Child
  • Ear Canal / diagnostic imaging
  • Ear Canal / pathology*
  • Humans
  • Magnetic Resonance Imaging
  • Necrosis
  • Otitis Externa* / diagnosis
  • Otitis Externa* / drug therapy
  • Otitis Externa* / microbiology
  • Otitis Externa* / physiopathology
  • Pseudomonas Infections* / diagnosis
  • Pseudomonas Infections* / drug therapy
  • Pseudomonas Infections* / physiopathology
  • Skull / diagnostic imaging
  • Skull / pathology*
  • Temporal Bone / diagnostic imaging
  • Temporal Bone / pathology
  • Tomography, X-Ray Computed