NECROTIZING OTITIS EXTERNA

1.NECROTIZING OTITIS EXTERNA ( Short note 2003)

A.k.a: Malignant Otitis Externa

 

DEFINITION:

Rare complication of Otitis Externa

Severe infection of temporal and adjacent bone

May lead to osteomyelitis of temporal bone and skull base

Commonly caused by Pseudomonas aeruginosa

Typically seen in immunocompromised and DM patients

 

COHEN DIAGNOSTIC CRITERIA:

 

MAJOR:

 

MINOR:

 

A-    MicroAbscess A – Age (elderly)
B-   Bone scan positive B – Bacterial culture (pseudomonas – 98%)
C-   Cruciating pain C – Cranial nerve palsy
D-   Discharge D – DM/ debilitating illness
E-   Edema E – ESR raised
G-  Granulation tissue  
F-   Failed medical therapy  

 

 

DIAGNOSIS:

Lab: ESR, swab c&s, HPE of granulation tissue, TWC, Glucose, Creatinine level

Imaging:

CT scan – to exclude temporal bone SCC. Findings: soft tissue enhancement in EAC +/- abscess

Technetium 99 – for diagnosis (absorbed by osteoclast and osteoblast)

Galium 67 – for prognosis (absorbed by macrophages)

 

TREATMENT:

Medical – IV abx (anti-pseudomonal): Ciprofloxacin 1/12, sugar control, pain control, ear toileting

Surgical – mastoidectomy + debridement of granulation tissue