Otitis externa symptoms, diagnosis and treatment bmj best. Malignant otitis externa is a devastating disease that poses a diagnostic and therapeutic challenge. Otitis externa oe is diffuse inflammation of the external auditory canal with or without infection. Otitis externa emergency department patient information. Malignant necrotizing external otitis also termed malignant otitis externa is an invasive infection of the external auditory canal and skull base, which typically occurs in elderly patients with diabetes mellitus. Acute otitis externa can progress to a chronic form either when the risk factors persist or when it is inadequately treated, especially the risk can be very significant when malignant otitis. The term external otitis also known as otitis externa or swimmers ear refers to inflammation of the external auditory canal or auricle. It is a severe infection that affects the ear canal bone cartilage and adjacent soft. In the netherlands,it has been estimated at 1214 per population per year,and has been shown to affect more than 1% of a sample population in the. Malignant necrotising external otitis is an invasive infection of the external auditory canal. In 1968, chandler created the term malignant otitis externa to describe this aggressive infection caused by pseu domonas aeruginosa 2. Aoe is uncommon before age 2 years, and very limited evidence exists with respecttotreatmentoroutcomesinthisagegroup.
Necrotizing malignant otitis externa is a relatively rare condition defined by destruction of the temporal bone beers and abramo, 2004. Otitis externa is a condition of the outer ear, caused by inflammation of the skin in the ear canal. Jul 08, 2016 fungal infection is uncommon for acute otitis externa, but plays role in chronic otitis externa or in those who have been treated with antibiotics. Increasing reports of malignant external otitis in patients infected with the human immunodeficiency virus hiv implicate a. Malignant otitis externa is an extension of oe into the mastoid and temporal bones. Otitis externa that has not resolved despite 23wks of topical antibiotics.
The inflammation is usually caused by infection, although it can sometimes be due to allergy or irritation. Otitis externa is an inflammatory condition of the external auditory canal the ear canal. Moe is an uncommon, but potentially fatal, complication of otitis externa affecting immunocompromised and elderly patients, particularly those with diabetes. The condition is often referred to as swimmers ear. It often presents with ear pain, swelling of the ear canal, and occasionally decreased hearing. Increasingly, however, nonpseudomonal cases are being reported. Individuals with underlying diabetes, disorders of the immune system, or history of radiation therapy to the base of the skull are more likely to develop complications, including malignant otitis externa. Malignant otitis externa meo is a rare complication of swimmers ear otitis externa. Otitis externa responds well to treatment, but complications may occur if it is not treated. Eight patients with malignant otitis externa underwent surgical debridement and a 69 week course of antibiotics. The term external otitis also known as otitis externa or swimmer ear refers to inflammation of the external auditory canal or auricle. Pain and itching are common symptoms and affect quality of life.
A rare, extremely severe form of otitis externa, known as malignant or necrotizing otitis externa, is caused by a pseudomonas infection that invades the posterior cranial bone. Otitis externa this leaflet will answer some of the questions you may have about the ear condition otitis externa. Management of necrotizing otitis externa the journal of. Necrotizing otitis externa noe, also known as malignant otitis externa, is a severe invasive infection of the external auditory canal eac which can spread rapidly to involve the surrounding soft tissue, adjacent neck spaces and skull base.
In the elderly, diabetics, aids patients, and the immunocompromised it may progress to malignant otitis externa moe. It occurs when an outer ear infection spreads to nearby tissue and bone. Typically there is pain with movement of the outer ear. Because of the potential for extendedduration, more severe infection, care providers should consider mrsa aoe when a patient presents and fails to improve quickly with empiric treatment.
Mar 09, 2020 otitis externa oe is an inflammation or infection of the external auditory canal eac, the auricle, or both. Malignant external otitis, also referred to as skull base osteomyelitis or necrotizing otitis externa, is typically a pseudomonas osteomyelitis of the temporal bone. Otalgia often out of proportion for routine otitis externa. Otitis externa is a common ear infection also known as swimmers ear. Malignant otitis externa moe is an invasive infection of the temporal bone that is classically caused by pseudomonas aeruginosa. The most common causative organism of malignant otitis externa is pseudomonas aeruginosa. The difference between otitis media and otitis externa. Malignant otitis externa is a severe complication of otitis externa. Also known as swimmers ear, otitis externa accounts for a significant portion of ambulatory care visits during the summer months, but can occur yearround in tropical or humid climates. This infection is known as malignant otitis externa. Malignant otitis externa may be suspected in older patients with diabetes mellitus or immunocompromise who have refrac tory purulent otorrhea and severe otalgia that may worsen at night. It is a common disease that can be found in all age groups. Malignant otitis externa moe is an aggressive and potentially lifethreatening infection of the soft tissues of the external ear and its surrounding structures, which quickly spreads to involve periosteum and bone of the skull base.
Despite advances in antibiotic treat ment, a significant proportion still succumbs to. Malignant otitis, without treatment, is a fatal condition. Otitis externa oe is a broad term that includes inflammation or infection of the external auditory canal. The skin which lines the outer ear canal becomes red and swollen due to infection by bacteria a germ or bug or fungus. It is characterised by redness, swelling, scaling and thickening of the canal skin lining and is accompanied by varying degrees of discomfort, itch, deafness and discharge. Malignant otitis externa in hiv and aids the journal of. Rosenfeld, 2014 the cellulitis can spread and lead to complications. Otitis externa, colloquially known as swimmers ear or tropical ear, is an infection of the external auditory canal figure 1. Etiology acute diffuse external otitis is usually caused by bacteria, such as pseudomonas aeruginosa, proteus vulgaris, staphylococcus aureus, or escherichia coli. Malignant otitis externa is associated with diabetes. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis.
Adults who have a weakened immune system are at a particularly increased risk of developing it. Malignant external otitis is an indolent osteitis seen in elderly diabetics. Malignant external otitis msd manual professional edition. American academy of otolaryngologyhead and neck surgery foundation. Toulmouche was probably the first physician to report a case of malignant external otitis meo, in 1838. Malignant otitis externa is caused by the spread of an outer ear infection otitis externa also called swimmers ear.
It often is called swimmers ear because it is associated with frequent swimming. Otitis externa, also called swimmers ear, is inflammation of the ear canal. Malignant otitis externa uf health, university of florida. Malignant otitis externa usually affects adults more than children. Malignant otitis externa may be suspected in older patients with diabetes mellitus or immunocompromise who have refractory purulent otorrhea and severe otalgia that may worsen at night. Infections originate from the external auditory channel and rapidly spread to the adjacent osseous and soft tissues. Malignant external otitis merck manuals professional edition. It develops in the ear canal leading to the eardrum.
Necrotizing otitis externa radiology reference article. The clinical manifestations and diagnosis of external otitis are discussed elsewhere. Necrotizing malignant external otitis, an infection involving the temporal and adjacent bones, is a relatively rare complication of external otitis. It typically occurs in the elderly diabetics or immunocompromised, presents with severe pain and headaches, requiring an urgent ct. May 03, 2017 malignant otitis externa isnt commonly a complication of swimmers ear. Herpes zoster oticus ramsay hunt syndrome malignant otitis externa. Further episodes of the condition can often be prevented by the tips given below.
We are seeing an increase in this condition in elderly people. Epidemiology the epidemiology of malignant external otitis has changed in the past 10 years. Malignant otitis externa moe, also known as necrotizing otitis externa, is an invasive bacterial infection that involves the external auditory canal and skull base. Despite the name, the term malignant does not mean you have cancer. In one recent study, 1 otitis externa was found to be disabling enough to cause 36 percent of patients to interrupt their daily activities for a median duration of four days, with 21 percent requiring bed rest. The difference between otitis media and otitis externa otitis media is an infection that affects the middle ear and arises in the tympanic cavity the hollow space between the tympanic membrane or ear drum and inner ear, whereas otitis externa is an infection in the external ear and the ear canal, and is popularly called swimmers ear or.
Although the differential diagnosis of the draining ear will be discussed, recommendations for management will be limited to. Otitis externa is an infection of the ear canal caused by bacteria or fungi. It is a severe infection that affects the ear canal bone cartilage and adjacent soft tissues. Acute otitis externa, also known as swimmers ear, is a common disease of children, adolescents and adults. Malignant otitis externa is a necrotising infection of the external ear canal which may spread to include the mastoid and petrous parts of the temporal bone, leading to skull base osteomyelitis. Otitis externa is a condition of the outer ear, caused by inflammation of the skin in the ear canal the tube between the outer ear and the eardrum. Malignant otitis externa is spread of otitis externa into the bone surrounding the ear canal the mastoid and temporal bones. In some cases, otitis externa can spread to surrounding tissue, including the bones of the jaw and face. Although elderly patients with diabetes remain the population most. External otitis is an acute infection of the ear canal skin typically caused by bacteria pseudomonas is most common. Malignant otitis externa, is a disease whose diagnosis and treatment is a challenge for any specialist.
This case report highlights fungal infection as a rare but important cause of malignant otitis externa moe. External otitis acute msd manual professional edition. The primary purpose is to promote appropriate use of oral and topical antimicrobials and to highlight the need for adequate pain relief. We have a typical case of malignant external otitis, a severe bacterial infection, caused by pseudomonas. Prolonged exposure to water, which may contain certain bacteria, makes the skin of the ear canal swollen and more likely to get infected. The development of malignant or necrotizing otitis externa is more common in diabetic and immunocompromised people. Otitis externa is inflammation of the external auditory meatus. Clinical findings include granulation tissue in the external auditory canal, especially at the bonecar tilage junction. Acute otitis externa aoe is defined as diffuse inflammation of the external ear canal, which may also involve the pinna or tympanic membrane. Malignant otitis externa is a serious, but rare, complication of otitis externa, where the infection spreads to the bone that surrounds your ear canal.
Acuteotitis externa aoe is the inflammation of outer ear and ear canal. A high fever is typically not present except in severe cases. Otitis externa causes clinical features management. Typically, the condition occurs when you have other health problems or youre receiving treatment that can weaken your. Pdf malignant otitis externa is an emerging problem in developing countries. It emphasises the clinical importance of considering fungal infection in refractory moe and describes the diagnosis and management with reference to the growing literature. Methicillinresistant staphylococcus aureus in acute. It can range from a mild inflammation to a potentially lifethreatening disease in older adults, otherwise known as necrotizing otitis externa. If you have any further questions or concerns, please speak to a doctor or nurse caring for you.
It is almost exclusively caused by infection with pseudomonas aeruginosa, and usually occurs in elderly noninsulindependent diabetic patients. Rosenfeld, 2014 cerumen actually serves a purpose and efforts to remove it can. Malignant otitis externa is a potentially life threatening infection of external auditory canal and skull base in an immunocompromised person. Malignant external otitis is a severe usually pseudomonas osteomyelitis of the temporal bone, usually affecting the elderly, diabetics, and immunocompromised patients.
Incidence of otitis externa is high in europe, and probably higher in the developing countries. It is a common, acute and chronic presentation to general practice, with around 10% of the population suffering at least one episode. Otitis externa is common and more than 1% of people will be diagnosed with the condition each year. Oct 19, 2016 otitis externa is an inflammation of the ear canal. Necrotizing malignant external otitis american family physician. Usually affecting immunocompromised patients, being diabetes mellitus. Treatment of the uncomplicated form is cleaning of the ear canal and application of topical antiinfective agents.
Chronic otitis externa lasts 3 months or longer, and is often attributed to allergic causes or related to inflammatory dermatological conditions. Malignant or necrotising otitis externa is a form of otitis externa that is more common in older patients with uncontrolled diabetes or in patients with immunodeficiency. Sylvester mj, sanghvi s, patel vm, eloy ja, ying ym. Granulation tissue often seen in the ear canal floor. Symptoms include pain, discharge, and hearing loss if the ear canal has swollen shut. Pdf malignant otitis externa in developing country c. In 1959, meltzer reported a case of pseudomonal osteomyelitis of the temporal bone. Otitis externa is an inflammatory process of the external auditory canal. Malignant otitis externa moe is a severe disease with varying outcomes. Usually affecting immunocompromised patients, being diabetes mellitus the most associated condition with up to 65% of cases. Malignant otitis externa is a serious but very rare complication of otitis externa, in which the infection spreads to the bone that surrounds your ear canal. Four categories of otitis externa that include acute localized otitis externa,diffuse otitis externa,chronic otitis externa,and malignant otitis externa. This infection is very common and affects all age groups. Emergency management in children 3 externa, malignant necrotising or skull base osteomyelitis otitis externa, acute otitis media with perforation, contact dermatitis, squamous cell carcinoma or adenocarcinoma of external auditory canal and retained foreign body, as these will all have varying treatment.
Malignant otitis externa is a disorder that involves infection and damage of the bones of the ear canal and at the base of the skull. Otitis externa maligna 1 yunis lourdes ramirez alcantara2. The outcome tends to be fatal due to the skull base osteomyelitis, especially if diagnois is. Malignant otitis externa moe is a rare fatal inflammatory disease of the external auditory canal, temporal bone, and skull base 1. Malignant external otitis case report abstract the purpose of this paper work is to share our attitude and results in the diagnosis and treatment of external malignant otitis by presenting a case diagnosed and treated.
Presents with rapid onset of ear pain, tenderness, itching, aural fullness, and hearing loss. This lifethreatening form of otitis externa affects primarily elderly patients with diabetes who live in hot, humid environments. This topic will focus on the treatment of external otitis. Baugh, md, university of toledo college of medicine, toledo, ohio. Otitis externa, also known as swimmers ear, is an inflammation of the outer ear. A diagnosis of diffuse aoe requires rapid onset generally within 48 hours in the past 3 weeks of symptoms and signs of ear canal in. The development of malignant or necrotising otitis externa is more common in diabetic and immunocompromised people. Otitis externa symptoms, diagnosis and treatment bmj. Also known as necrotizing external otitis, it is an aggressive form of oe. Potential complications of otitis externa include malignant otitis externa, mastoiditis, osteomyelitis, and intracranial spread. In fact, the only case of malignant otitis externa among this cohort was a patient with mrsa aoe. While chronic suppurative otitis media or acute otitis media with tympanostomy tubes or a perforation can cause acute otitis externa, both the infecting organisms and management protocol are different. The disease extent as determined on ct and at surgery dictated the nature of surgery.
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