Malignant otitis
externa
Anita Olivero
1767
Definition
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.
Causes
Malignant otitis externa is caused by the
spread of an outer ear infection (otitis
externa), also called swimmer's ear. It is
not common.
External otitis is often caused by bacteria,
such as pseudomonas(can occur as
fungal infection like aspergillosis).
The infection spreads from the floor of the
ear canal to the nearby tissues and into
the bones at the base of the skull. The
infection and swelling may damage or
destroy the bones. The infection may
affect the cranial nerves, brain, or other
parts of the body if it continues to spread.
Symptoms
Ongoing drainage from the ear that is
yellow or green and smells bad.
Ear pain deep inside the ear. Pain may
get worse when you move your head.
Hearing loss.
Itching of the ear or ear canal.
Fever.
Trouble swallowing.
Weakness in the muscles of the face.
Exams and Tests
The head around and behind the ear may be tender to touch. A neurological exam may
show that the cranial nerves are affected.
If there is any drainage, the provider may send a sample of it to the lab. The lab will
culture the sample to try to find the cause of the infection.
To look for signs of a bone infection next to the ear canal, the following tests may be done:
CT scan of the head
MRI scan of the head
Radionuclide scan
Treatment
1. Systemic antibiotics, typically a fluoroquinolone and/or an
aminoglycoside/semisynthetic penicillin combination
2. Topical antibiotic/corticosteroid preparations (eg, ciprofloxacin/dexamethasone)
3. Rarely, surgical debridement
4. Treatment of malignant external otitis is typically with a 6-week IV course of a
culture-directed fluoroquinolone and/or a semisynthetic penicillin (piperacillin–
tazobactam or piperacillin)/aminoglycoside combination (for ciprofloxacin
resistant Pseudomonas).
5. Mild cases may be treated with a high-dose oral fluoroquinolone (eg, ciprofloxacin,
750 mg orally every 12 hours) on an outpatient basis with close follow-up.
6. Treatment also includes topical ciprofloxacin/dexamethasone preparations (eg, ear
drops, impregnated canal dressings) and serial debridement.
7. Frequent office debridement is necessary to remove granulation tissue and
purulent discharge. Surgery usually is not necessary, but surgical debridement to
clear necrotic tissue may be used for more extensive infections.
