MALIGNANT (NECROTISING) OTITIS EXTERNA:
- It is an inflammatory condition caused by pseudomonas infection usually in the elderly diabetics, or in those on immunosuppressive drugs.
- Its early manifestations resemble diffuse otitis externa but there is excruciating pain and appearance of granulations in the meatus. Facial paralysis is common. 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.
- CT scan is useful, to know the extent of disease.
- Treatment consists of high doses of i.v. antibiotics directed against pseudomonas (tobramycin, ticarcillin or third generation cephalosporins). Antibiotics are given for 6-8 weeks or longer. Diabetes should be controlled. Surgical debridement of devitalised tissue and bone should be done judiciously.
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