Malignant Otitis Externa

MALIGNANT OTITIS EXTERNA
  • Necrotizing otitis externa or skull base osteomyelitis
  • Caused by Pseudomonas aeruginosa infection
  • Diabetes is the major predisposing factor
  • Can occur in Immuno-compromised Patients
  • Severe pain worsening at night
  • Presence of granulations at bony cartilaginous junction (Also in Floor of External Auditory Canal)
  • Biopsy and radical surgery to be avoided
  • Multiple cranial nerve palsies can occur – Most Common – Facial Nerve Palsy
  • Infection may spread to the skull base and jugular foramen causing multiple cranial nerve palsies.
  • Anteriorly, infection spreads to temporomandibular fossa,
  • Posteriorly to the mastoid and medially into the middle ear and petrous bone.
  • Most common nerve palsy – facial nerve
  • Gallium-67 scan is useful in diagnosis and follow-up
  • Treatment: diabetes control, antibiotics, surgery (drainage of subperiosteal abscess, removal of necrotic tissue and sequestrated bone)
Exam Question
  • Caused by Pseudomonas aeruginosa infection
  • Diabetes is the major predisposing factor
  • Can occur in Immuno-compromised Patients
  • Severe pain worsening at night
  • Presence of granulations at bony cartilaginous junction (Also in Floor of External Auditory Canal)
  • Biopsy and radical surgery to be avoided
  • Multiple cranial nerve palsies can occur – Most Common – Facial Nerve Palsy

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