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VOLUME 14 , ISSUE 1 ( January-April, 2022 ) > List of Articles


Principles in Malignant Otitis Externa

Sergul Ulus, Eyup Baz, Bulent Evren Erkul, Ibrahim Engin Cekin

Keywords : Malignant otitis externa, Mastoidectomy, Necrotizing otitis externa

Citation Information : Ulus S, Baz E, Erkul BE, Cekin IE. Principles in Malignant Otitis Externa. Int J Otorhinolaryngol Clin 2022; 14 (1):1-6.

DOI: 10.5005/jp-journals-10003-1415

License: CC BY-NC 4.0

Published Online: 22-04-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Objective: Malignant otitis externa (MOE) is a serious and recalcitrant disease with its morbidity and mortality. This infection and inflammation can spread easily and attack cranial nerves (CNs) and the skull base, even though it starts with simple otitis externa. Methods: This retrospective observational study agglomerates 10 MOE cases, including their diagnosis, follow-up, and treatment. Results: Otalgia that especially increases at night was the most common symptom. Diabetes was present in all patients. Seven cases had associated facial palsy. Half of the patients underwent mastoidectomy. Six patients were cured of MOE. Conclusion: Management of diabetes is the first step of the treatment. In our study, we could not demonstrate the contribution of mastoidectomy to the outcome. Resolution of cranial neuropathy is associated with good prognostic signs.

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  1. Meltzer PE, Keleman G. Pyocyaneous osteomyelitis of the temporal bone, mandible, and zygoma. Laryngoscope 1959;69:1300. DOI: 10.1288/00005537-195910000-00006.
  2. Chen JC, Yeh CF, Shiao AS, et al. Temporal bone osteomyelitis: the relationship with malignant otitis externa, the diagnostic dilemma, and changing trends. Sci World J 2014;2014:591714. DOI: 10.1155/2014/591714.
  3. Kumar SP, Ravikumar A, Somu L, et al. Malignant otitis externa: an emerging scourge. J Clin Gerontol Geriatr 2013;4:128–131. DOI: 10.1016/j.jcgg.2013.02.003.
  4. Carfrae MJ, Kesser BW. Malignant otitis externa. Otolaryngol Clin North Am 2008;41(3):537–549, viii–ix. DOI: 10.1016/j.otc.2008.01.004.
  5. Soheilipour S, Meidani M, Derakhshandi H, et al. Necrotizing external otitis: a case series. B-ENT 2013;9(1):61–66. PMID: 23641593.
  6. Chen YA, Chan KC, Chen CK, et al. Differential diagnosis and treatments of necrotizing otitis externa: a report of 19 cases. Auris Nasus Larynx 2011;38(6):666–670. DOI: 10.1016/j.anl.2011.01.020.
  7. Karaman E, Yilmaz M, Ibrahimov M, et al. Malignant otitis externa. J Craniofac Surg 2012;23(6):1748–1751. DOI: 10.1097/SCS.0b013e31825e4d9a.
  8. Bhat V, Aziz A, Bhandary SK, et al. Malignant otitis externa–a retrospective study of fifteen patients treated in a tertiary healthcare center. J Int Adv Otol 2015;11(1):72–76. DOI: 10.5152/iao.2015.430.
  9. Driss N, Mighri K, Hassine M, et al. L'otite externe maligne (à propos de deux observations) [Malignant otitis externa (2 cases)]. Tunis Med 1993;71(11):541–545. PMID: 8310547.
  10. Stokkel MP, Boot CN, van Eck-Smit BL. SPECT gallium scintigraphy in malignant external otitis: initial staging and follow-up. Case reports. Laryngoscope 1996;106(3 Pt 1):338–340. DOI: 10.1097/00005537-199603000-00018.
  11. Sudhoff H, Rajagopal S, Mani N, et al. Usefulness of CT scans in malignant external otitis: effective tool for the diagnosis, but of limited value in predicting outcome. Eur Arch Otorhinolaryngol 2008;265(1):53–56. DOI: 10.1007/s00405-007-0416-8.
  12. Kaya İ, Sezgin B, Eraslan S, et al. Malignant otitis externa: a retrospective analysis and treatment outcomes. Turk Arch Otorhinolaryngol 2018;56(2):106–110. DOI: 10.5152/tao.2018.3075.
  13. Jacobsen LM, Antonelli PJ. Errors in the diagnosis and management of necrotizing otitis externa. Laryngoscope 2010;120 (Suppl 4):S207. DOI: 10.1002/lary.21673.
  14. Tarazi AE, Al-Tawfiq JA, Abdi RF. Fungal malignant otitis externa: pitfalls, diagnosis, and treatment. Otol Neurotol 2012;33(5):769–773. DOI: 10.1097/MAO.0b013e3182565b46.
  15. Rubin J, Stoehr G, Yu VL, et al. Efficacy of oral ciprofloxacin plus rifampin for treatment of malignant external otitis. Arch Otolaryngol Head Neck Surg 1989;115(9):1063–1069. DOI: 10.1001/archotol.1989.01860330053016.
  16. Chandler JR. Malignant external otitis. Laryngoscope 1968;78(8): 1257–1294. DOI: 10.1288/00005537-196808000-00002.
  17. Ulus S, Tosun F, Durmaz A, et al. Evaluation of various forms of sinusitis using bone Spect. World Allergy Organ J 2012;5(Suppl 2):S65–S65. DOI: 10.1097/01.WOX.0000411889.29277.dc.
  18. Carlton DA, Perez EE, Smouha EE. Malignant external otitis: The shifting treatment paradigm. Am J Otolaryngol 2018;39(1):41–45. DOI: 10.1016/j.amjoto.2017.05.010.
  19. Hatch JL, Bauschard MJ, Nguyen SA, et al. Malignant otitis externa outcomes: a study of the university healthsystem consortium database. Ann Otol Rhinol Laryngol 2018;127(8):514–520. DOI: 10.1177/0003489418778056.
  20. Amaro CE, Espiney R, Radu L, et al. Malignant (necrotizing) externa otitis: the experience of a single hyperbaric centre. Eur Arch Otorhinolaryngol 2019;276(7):1881–1887. DOI: 10.1007/s00405-019-05396-7.
  21. Phillips JS, Jones SE. Hyperbaric oxygen as an adjuvant treatment for malignant otitis externa. Cochrane Database Syst Rev 2013;2013(5):CD004617. DOI: 10.1002/14651858.CD004617.
  22. Franco-Vidal V, Blanchet H, Bebear C, et al. Necrotizing external otitis: a report of 46 cases. Otol Neurotol 2007;28(6):771–773. DOI: 10.1097/MAO.0b013e31805153bd.
  23. Mani N, Sudhoff H, Rajagopal S, et al. Cranial nerve involvement in malignant external otitis: implications for clinical outcome. Laryngoscope 2007;117(5):907–910. DOI: 10.1097/MLG.0b013e318039b30f.
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