Hostname: page-component-7dd5485656-6kn8j Total loading time: 0 Render date: 2025-10-30T18:29:07.915Z Has data issue: false hasContentIssue false
  • English
  • Français

Malignant otitis externa, an increasing burden in the twenty-first century: review of cases in a UK teaching hospital, with a proposed algorithm for diagnosis and management

Published online by Cambridge University Press:  12 April 2019

K H Hutson  and
G J Watson
K H Hutson
Affiliation:
Otolaryngology Head and Neck Department, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
G J Watson*
Affiliation:
Otolaryngology Head and Neck Department, Sheffield Teaching Hospitals NHS Foundation Trust, UK
*
Author for correspondence: Mr G J Watson, Otolaryngology Head and Neck Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK E-mail: glen.watson@sth.nhs.uk Fax: +44 (0)114 271 1985
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Malignant otitis externa is a potentially fatal infection of the skull base. With an ageing population and increasing prevalence of diabetes, the incidence of malignant otitis externa in the British population is rising. To date, there remain no accepted diagnostic criteria, few prognostic indicators and no consensus treatment pathways.

Method

A prospective case series was conducted at a tertiary referral teaching hospital.

Results

A cohort of susceptible individuals predominates (elderly, male, with immunosuppression and diabetes), with 25 per cent reporting a preceding incident. Otorrhoea, otalgia and canal granulation were the commonest presenting features, alongside positive pseudomonas cultures. No clear markers for predicating disease severity were isolated; however, a high initial haemoglobin A1c level demonstrated a significant moderately positive correlation with length of treatment.

Conclusion

A treatment pathway designed to provide a standardised approach to investigation and treatment is proposed, which aims to increase earlier diagnosis, streamline care and facilitate the development of best practice.

Keywords

Otitis ExternaPseudomonasDiabetes MellitusSkull Base

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 5 , May 2019 , pp. 356 - 362
Copyright
Copyright © JLO (1984) Limited, 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

Mr G J Watson takes responsibility for the integrity of the content of the paper

Presented at the 31st Politzer Society meeting, 21–24 February 2018, Las Palmas de Gran Canaria, Spain.

References

1Mehrotra, P, Elbadawey, MR, Zammit-Maempel, I. Spectrum of radiological appearances of necrotizing external otitis: a pictorial review. J Laryngol Otol 2011;125:1109–15Google Scholar
2Pankhania, M, Bashyam, A, Judd, O, Jassar, P. Antibiotic prescribing trends in necrotising otitis externa: a survey of 85 trusts in the United Kingdom: our experience. Clin Otolaryngol 2016;41:293–6Google Scholar
3Chandler, JR. Malignant external otitis. Laryngoscope 1968;78:1257–94Google Scholar
4Chawdhary, G, Liow, N, Democratis, J, Whiteside, O. Necrotising (malignant) otitis externa in the UK: a growing problem. Review of five cases and analysis of national Hospital Episode Statistic trends. J Laryngol Otol 2015;129:600–3Google Scholar
5Mahdyoun, P, Pulcini, C, Gahide, I, Raffaelli, C, Savoldelli, C, Castillo, L et al. Necrotizing otitis externa: a systematic review. Otol Neurotol 2013;34:620–9Google Scholar
6Kaushik, V, Malik, T, Saeed, SR. Interventions for acute otitis externa. Cochrane Database Syst Rev 2010;(20):CD004740Google Scholar
7Cohen, D, Freidman, P. The diagnostic criteria of malignant external otitis. J Laryngol Otol 1987;101:216–21Google Scholar
8Stevens, SM, Lambert, PR, Baker, AB, Meyer, TA. Malignant otitis externa: a novel stratification protocol for predicting treatment outcomes. Otol Neurotol 2015;36:1492–8Google Scholar
9Loh, S, Loh, WS. Malignant otitis externa: an Asian perspective on treatment outcomes and prognostic factors. Otolaryngol Head Neck Surg 2013;148:991–6Google Scholar
10Franco-Vidal, V, Blanchet, H, Bebear, C, Dutronc, H, Darrouzet, V. Necrotizing external otitis: a report of 46 cases. Otol Neurotol 2007;28:771–3Google Scholar
11Sreepada, GS, Kwartler, JA. Skull base osteomyelitis secondary to malignant otitis externa. Curr Opin Otolaryngol Head Neck Surg 2003;11:316–23Google Scholar
12Peleg, U, Perez, R, Raveh, D, Berelowitz, D, Cohen, D. Stratification for malignant external otitis. Otolaryngol Head Neck Surg 2007;137:301–5Google Scholar
13Soudry, E, Hamzany, Y, Preis, M, Joshua, B, Hadar, T, Nageris, BI. Malignant external otitis: analysis of severe cases. Otolaryngol Head Neck Surg 2011;144:758–62Google Scholar
14Joshua, BZ, Sulkes, J, Raveh, E, Bishara, J, Nageris, BI. Predicting outcome of malignant external otitis. Otol Neurotol 2008;29:339–43Google Scholar
15Carlton, DA, Perez, EE, Smouha, EE. Malignant external otitis: the shifting treatment paradigm. Am J Otolaryngol 2018;39:41–5Google Scholar
16Djalilian, HR, Shamloo, B, Thakkar, KH, Najme-Rahim, M. Treatment of culture-negative skull base osteomyelitis. Otol Neurotol 2006;27:250–5Google Scholar
17Bernstein, JM, Holland, NJ, Porter, GC, Maw, AR. Resistance of pseudomonas to ciprofloxacin: implications for the treatment of malignant otitis externa. J Laryngol Otol 2007;121:118–23Google Scholar
18Berenholz, L, Katzenell, U, Harell, M. Evolving resistant pseudomonas to ciprofloxacin in malignant otitis externa. Laryngoscope 2002;11:1619–22Google Scholar
19Rubin Grandis, J, Branstetter, BF, Yu, VL. The changing face of malignant (necrotising) external otitis: clinical, radiological and anatomic correlations. Lancet Infect Dis 2004;4:34–9Google Scholar
20Pulcini, C, Mahdyoun, P, Cua, E, Gahide, I, Castillo, L, Guevara, N. Antibiotic therapy in necrotising external otitis: case series of 32 patients and review of the literature. Eur J Clin Microbiol Infect Dis 2012;31:3287–94Google Scholar
21Courson, AM, Vikram, HR, Barrs, DM. What are the criteria for terminating treatment for necrotizing (malignant) otitis externa? Laryngoscope 2014;124:361–2Google Scholar
22Singh, A, Al Khabori, M, Hyder, MJ. Skull base osteomyelitis; diagnostic and therapeutic challenges in atypical presentation. Otolaryngol Head Neck Surg 2005;133:121–5Google Scholar
23Al-Noury, K, Lotfy, A. Computed tomography and magnetic resonance imaging findings before and after treatment of patients with malignant external otitis. Eur Arch Otorhinolaryngol 2011;268:1727–34Google Scholar
24Phillips, JS, Jones, SE. Hyperbaric oxygen as an adjunct treatment for malignant otitis externa. Cochrane Database Syst Rev 2013;(31):CD004617Google Scholar