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Malignant otitis externa: case series

Published online by Cambridge University Press:  14 April 2010

T Ali ,
K Meade ,
S Anari ,
M R ElBadawey  and
I Zammit-Maempel
T Ali
Affiliation:
Department of Radiology, Freeman Hospital, Newcastle upon Tyne, UK
K Meade
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK
S Anari*
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK
M R ElBadawey
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK
I Zammit-Maempel
Affiliation:
Department of Radiology, Freeman Hospital, Newcastle upon Tyne, UK
*
Address for correspondence: Mr Shahram Anari, 33 Thornbury Close, Newcastle upon Tyne NE3 2FD, UK. E-mail: sssanari@yahoo.co.uk
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Abstract

Background:

In the light of current concerns regarding ciprofloxacin resistance and the changing face of malignant otitis externa, we reviewed cases of malignant otitis externa treated in our centre, in order both to evaluate the current epidemiology of the condition and to assess the status of drug resistance in our patient population.

Method:

Retrospective case review of all malignant otitis externa cases managed in a tertiary referral centre in the north-east of England between 2000 and 2009.

Results:

Forty-one patients were identified, but the required data were available for only 37 cases. Patients' ages ranged from 51 to 101 years (median, 81 years). Diabetes was present in 51 per cent of patients (19/37), facial nerve palsy in 40 per cent (15/37) and multiple cranial nerve palsy in 24 per cent (9/37). Pseudomonas aeruginosa was the most commonly isolated organism (54 per cent), sensitive to ciprofloxacin in all cases.

Conclusions:

The incidence of cranial nerve palsy in our study was higher than in previous reports. The incidence of diabetes and Pseudomonas aeruginosa in our cohort was much lower than previously reported. The Pseudomonas aeruginosa strains isolated were all sensitive to ciprofloxacin, despite recent reports on emerging resistance.

Keywords

Malignant Otitis ExternaNecrotizing Otitis ExternaPseudomonas AeruginosaOtitis ExternaExternal Otitis
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 8 , August 2010 , pp. 846 - 851
Copyright
Copyright © JLO (1984) Limited 2010

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References

1 Toulmouche, MA. Observations on cerebral otorrhoea: further deliberations [in French]. Gaz Med Paris 1838;6:422–6Google Scholar
2 Meltzer, PE, Keleman, G. Pyocyaneous osteomyelitis of the temporal bone, mandible, and zygoma. Laryngoscope 1959;69:1300–16CrossRefGoogle Scholar
3 Chandler, JR. Malignant external otitis. Laryngoscope 1968;78:1257–94CrossRefGoogle ScholarPubMed
4 Nadol, JB Jr. Histopathology of pseudomonas osteomyelitis of the temporal bone starting as malignant external otitis. Am J Otolaryngol 1980;1:359–71CrossRefGoogle ScholarPubMed
5 Rowlands, RG, Lekakis, GK, Hinton, AE. Masked pseudomonal skull base osteomyelitis presenting with bilateral Xth cranial nerve palsy. J Laryngol Otol 2002;116:556–8CrossRefGoogle ScholarPubMed
6 Amorosa, L, Modugno, GC, Pirodda, A. Malignant external otitis: review and personal experience. Acta Otolaryngol Suppl 1996;521:3–16CrossRefGoogle ScholarPubMed
7 Bhandary, S, Karki, P, Sinha, BK. Malignant otitis externa: a review. Pac Health Dialog 2002;9:64–7Google ScholarPubMed
8 Slattery, WH 3rd, Brackmann, DE. Skull base osteomyelitis. Malignant external otitis. Otolaryngol Clin North Am 1996;29:795–806CrossRefGoogle ScholarPubMed
9 Carfrae, MJ, Kesser, BW. Malignant otitis externa. Otolaryngol Clin North Am 2008;41:537–49CrossRefGoogle ScholarPubMed
10 Rubin Grandis, J, Branstetter, BF 4th, Yu, VL. The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis 2004;4:34–9CrossRefGoogle ScholarPubMed
11 Mani, N, Sudhoff, H, Rajagopal, S, Moffat, D, Axon, PR. Cranial nerve involvement in malignant external otitis: implications for clinical outcome. Laryngoscope 2007;117:907–10CrossRefGoogle ScholarPubMed
12 Salit, IE, McNeely, D, Chait, G. Invasive external otitis: review of 12 cases. Can Med Assoc J 1985;132:381–4Google ScholarPubMed
13 Soudry, E, Joshua, BZ, Sulkes, J, Nageris, BI. Characteristics and prognosis of malignant external otitis with facial paralysis. Arch Otolaryngol Head Neck Surg 2007;133:1002–4CrossRefGoogle ScholarPubMed
14 Chandler, JR. Malignant otitis externa and osteomyelitis of the base of the skull. Am J Otol 1989;10:108–10Google ScholarPubMed
15 Kohut, RI, Lindsay, JR. Necrotizing (“malignant”) external otitis histopathologic processes. Ann Otol Rhinol Laryngol 1979;88:714–20CrossRefGoogle ScholarPubMed
16 Babiatzki, A, Sadé, J. Malignant external otitis. J Laryngol Otol 1987;101:205–10CrossRefGoogle ScholarPubMed
17 Ress, BD, Luntz, M, Telischi, FF, Balkany, TJ, Whiteman, ML. Necrotizing external otitis in patients with AIDS. Laryngoscope 1997;107:456–60CrossRefGoogle ScholarPubMed
18 Salit, IE, Miller, B, Wigmore, M, Smith, JA. Bacterial flora of the external canal in diabetics and non-diabetics. Laryngoscope 1982;92:672–3CrossRefGoogle ScholarPubMed
19 Sudhoff, H, Rajagopal, S, Mani, N, Moumoulidis, I, Axon, PR, Moffat, D. Usefulness of CT scans in malignant external otitis: effective tool for the diagnosis, but of limited value in predicting outcome. Eur Arch Otorhinolaryngol 2008;265:53–6CrossRefGoogle ScholarPubMed
20 Grandis, JR, Curton, HD, Yu, VL. Necrotizing (malignant) external otitis: prospective comparison of CT and MR imaging in diagnosis and follow-up. Radiology 1995;196:499–504CrossRefGoogle Scholar
21 Ismail, H, Hellier, WP, Batty, V. Use of magnetic resonance imaging as the primary imaging modality in the diagnosis and follow-up of malignant external otitis. J Laryngol Otol 2004;118:576–9CrossRefGoogle ScholarPubMed
22 Okpala, NCE, Siraj, QH, Nilssen, E, Pringle, M. Radiological and radionuclide investigation of malignant otitis externa. J Laryngol Otol 2005;119:71–5CrossRefGoogle ScholarPubMed
23 Berenholz, L, Katzenell, U, Harell, M. Evolving resistant pseudomonas to ciprofloxacin in malignant otitis externa. Laryngoscope 2002;112:1619–22CrossRefGoogle ScholarPubMed
24 Kimmelman, CP, Lucente, FE. Use of ceftazidime for malignant external otitis. Ann Otol Rhinol Laryngol 1989;98:721–5CrossRefGoogle ScholarPubMed
25 Johnson, MP, Ramphal, R. Malignant external otitis: report on therapy with ceftazidime and review of therapy and prognosis. Rev Infect Dis 1990;12:173–80CrossRefGoogle Scholar
26 Phillips, JS, Jones, SE. Hyperbaric oxygen as an adjuvant treatment for malignant otitis externa. Cochrane Database Syst Rev 2005;(18):CD004617CrossRefGoogle ScholarPubMed
27 Bernstein, JM, Holland, NJ, Porter, GC, Maw, AR. Resistance of pseudomonas to ciprofloxacin: implications for the treatment of malignant otitis externa. J Laryngol Otol 2007;121:118–23CrossRefGoogle ScholarPubMed
28 Joshua, BZ, Sulkes, J, Raveh, E, Bishara, J, Nageris, BI. Predicting outcome of malignant external otitis. Otol Neurotol 2008;29:339–43CrossRefGoogle ScholarPubMed