Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-28T17:26:58.618Z Has data issue: false hasContentIssue false
  • English
  • Français

Management of malignant (necrotising) otitis externa

Published online by Cambridge University Press:  03 October 2011

S Hollis  and
K Evans
S Hollis*
Affiliation:
ENT Department, Gloucestershire Royal Hospital, Gloucester, UK
K Evans
Affiliation:
ENT Department, Gloucestershire Royal Hospital, Gloucester, UK
*
Address for correspondence: Miss Sophie Hollis, ENT Department, Gloucestershire Royal Hospital, Gloucester GL1 3NN, UK Fax: +44 (0)8454 226432 E-mail: sophie_hollis@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Although malignant (necrotising) otitis externa is not a common diagnosis, there have been a number of recently reported cases with pathogens other than Pseudomonas aeruginosa as the causative organism. In addition, there are many published reports of resistance to antibiotics in cases of malignant otitis externa caused by Pseudomonas aeruginosa. This review aims to assess the cases reported and to clarify the current opinion on the diagnostic criteria and management of such cases.

Keywords

Otitis ExternaDiagnosisDrug ResistanceSurgeryManagement
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 125 , Issue 12 , December 2011 , pp. 1212 - 1217
Copyright
Copyright © JLO (1984) Limited 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Chandler, JR. Malignant Otitis Externa. Laryngoscope 1968;78:1257–94CrossRefGoogle Scholar
2el-Silimy, O, Sharnuby, M. Malignant otitis externa: management policy. J Laryngol Otol 1992;106:5–6Google Scholar
3Phillips, JS, Jones, SE. Cochrane Database Syst Rev 2005;(18):CD004617Google Scholar
4Berenholz, L, Katsenell, U, Harell, M. Evolving resistant Pseudomonas to ciprofloxacin in malignant otitis externa. Laryngoscope 2002;112:1619–22CrossRefGoogle ScholarPubMed
5Mani, N, Sudhoff, H, Rajagopal, S, Moffat, D, Axon, PR. Cranial nerve involvement in malignant otitis externa: implications for clinical outcome. Laryngoscope 2007;117:907–10Google Scholar
6Shpitzer, T, Stern, Y, Cohen, O, Levy, R, Segal, K, Feinmesser, R. Malignant otitis externa in nondiabetic patients. Ann Otol Rhinol Laryngol 1993;102:870–2Google Scholar
7Sobie, S, Brodsky, L, Stanievich, JF. Necrotizing external otitis in children: report of two cases and review of the literature. Laryngoscope 1987;97:598–601CrossRefGoogle ScholarPubMed
8Rubin, J, Yu, VL. Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis and therapy. Am J Med 1988;85:391–8Google Scholar
9Ford, GR, Courteney-Harris, RG. Another hazard of ear syringing: malignant external otitis. J Laryngol Otol 1990;104:709–10Google Scholar
10Driscoll, PV, Ramachandrula, A, Drezner, DA, Hicks, TA, Schaffer, SR. Characteristics of cerumen in diabetic patients: a key to understanding malignant otitis externa. Otolaryngol Head Neck Surg 1993;109:676–9Google Scholar
11Campos, A, Betancor, L, Arias, A, Rodríguez, C, Hernández, AM, López Aguado, D et al. Influence of human wet cerumen on the growth of common and pathogenic bacteria of the ear. J Laryngol Otol 2000;114:925–9CrossRefGoogle ScholarPubMed
12Oya-Ito, T, Naitou, H, Masuda, S, Kinae, N, Ohashi, N. Functional analyses of neutrophil-like differentiated cell lines under a hyperglycaemic condition. Mol Nutr Food Res 2008;52:360–9CrossRefGoogle Scholar
13Rubin, J, Yu, VL, Stool, SE. Malignant external otitis in children. J Pediatr 1988;113:965–70CrossRefGoogle ScholarPubMed
14Cohen, D, Friedman, P. The diagnostic criteria of malignant external otitis. J Laryngol Otol 1987;101:216–21Google Scholar
15Joshua, BZ, Sulkes, J, Raveh, E, Bishara, J, Nageris, BI. Predicting outcome of malignant external otitis. Otol Neurotol 2008;29:339–43CrossRefGoogle ScholarPubMed
16Soudry, 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
17Sudhoff, 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
18Levin, WJ, Shary, JH, Nichols, LT, Lucente, FE. Bone scanning in severe external otitis. Laryngoscope 1986;96:1193–5CrossRefGoogle ScholarPubMed
19Okpala, NCE, Siraj, QH, Nilssen, E, Pringle, M. Radiological and radionuclide investigation of malignant otitis externa. J Laryngology Otol 2005;119:71–5Google Scholar
20Grandis, JR, Curtin, HD, Yu, VL. Necrotising (malignant) external otitis: prospective comparison of CT and MR imaging in diagnosis and follow up. Radiology 1995;196:499–504CrossRefGoogle Scholar
21Ninkovic, G, Dullo, V, Saunders, NC. Microbiology of otitis externa in the secondary care in United Kingdom and antimicrobial sensitivity. Auris Nasus Larynx 2008;35:480–4Google Scholar
22Carfrae, MJ, Kesser, BW. Malignant otitis externa. Otolaryngol Clin North Am 2008;41:537–49CrossRefGoogle ScholarPubMed
23Englender, M, Harrell, M, Guttman, R, Segal, S. Typing of Psuedomonas aeruginosa ear infections related to outcome of treatment. J Laryngol Otol 1990;104:678–81Google Scholar
24Garcia Rodriguez, JA, Montes Martinez, I, Gómez González, JL, Ramos Macías, A, López Alburquerque, T. A case of malignant external otitis involving Klebsiella oxytoca. Eur J Clin Microbiol Infect Dis 1992;11:75–7CrossRefGoogle ScholarPubMed
25Bayardelle, P, Jolivet-Granger, M, Larochelle, D. Staphylococcal malignant otitis externa. Can Med Assoc J 1982;126:155–6Google Scholar
26Barrow, HN, Levenson, MJ. Necrotising “malignant” external otitis caused by Staphylococcal epidermidis. Arch Otolaryngol Head Neck Surg 1992;118:94–6Google Scholar
27Menachof, MR, Jackler, RK. Otogenic skull base osteomyelitis caused by invasive fungal infection. Otolaryngol Head Neck Surg 1990;102:285–9Google Scholar
28Bellini, C, Antonini, P, Ermanni, S, Dolina, M, Passega, E, Bernasconi, E. Malignant otitis externa due to Aspergillus niger. Scand J Infect Dis 2003;35:284–8CrossRefGoogle ScholarPubMed
29Kountakis, SE, Kemper, JV Jr, Chang, CY, DiMaio, DJ, Stiernberg, CM. Osteomyelitis of the base of the skull secondary to aspergillus. Am J Otolaryngol 1997;18:19–22Google Scholar
30Bae, WK, Lee, KS, Park, JW, Bae, EH, Ma, SK, Kim, NH et al. A case of malignant otitis externa caused by Candida glabrata in a patient receiving haemodialysis. Scand J Infect Dis 2007;39:370–2CrossRefGoogle Scholar
31Rubin Grandis, J, Branstetter, BF 4th, Yu, VL. The changing face of malignant (necrotising) externa otitis. Lancet Infect Dis 2004;4:34–9CrossRefGoogle Scholar
32Barza, M. Pharmacokinetics and efficacy of new quinolones in infections of the eye, ear, nose and throat. Rev Infect Dis 1988;10(suppl 1):S241–7Google Scholar
33Peleg, U, Perez, R, Raveh, D, Berelowitz, D, Cohen, D. Stratification for malignant external otitis. Otolaryngol Head Neck Surg 2007;137:301–5Google Scholar
34Rosenfeld, RM, Singer, MS, Wasserman, JM, Stinnett, SS. Systematic review of topical antimicrobial therapy for acute otitis externa. Otolaryngol Head Neck Surg 2006;134(Suppl 4):S24–48Google Scholar
35O'Donnell, JA, Gelone, SP. Fluoroquinolones. Infectious Disease Clinics of North America 2000;14:489–513CrossRefGoogle ScholarPubMed
36Schentag, JJ, Scully, BE. Quinolones. In: Yu, VL, Merigan, TC, Barriere, S, eds. Antimicrobial Therapy and Vaccines. Baltimore: Williams & Wilkins, 1999;875Google Scholar
37Lew, DP, Waldvogel, FA. Quinolones and osteomyelitis: state-of-the-art. Drugs 1995;49(suppl 2):100–11CrossRefGoogle ScholarPubMed
38Flor, S, Guay, D, Opsahl, J, Tack, K, Matzke, G. Pharmacokinetics of ofloxacin in healthy subjects and patients with varying degrees of renal impairment. Int J Clin Pharmacol Res 1991;11:115–21Google ScholarPubMed
39Rubin, J, Stoehr, G, Yu, VL, Muder, RR, Matador, A, Kamerer, DB. Efficacy of oral ciprofloxacin plus rifampicin for treatment of malignant external otitis. Arch Otolaryngol Head Neck Surg 1989;115:1063–9Google Scholar
40Johnson, MP, Ramphal, R. Malignant external otitis: report on therapy with ceftazadime and review of therapy and prognosis. Rev Infect Dis 1990;12:173–80Google Scholar
41Giamarellou, H. Therapeutic guidelines for Pseudomonas aeruginosa infections. Int J Antimicrob Agents 2000;16:103–6Google Scholar
42Lee, YJ, Liu, HY, Lin, YC, Sun, KL, Chun, CL, Hsueh, PR. Fluoroquinolone resistance of Pseudomonas aeruginosa isolates causing nosocomial infection is correlated with levofloxacin but not ciprofloxacin use. Int J Antimicrob Agents 2010;35:261–4CrossRefGoogle Scholar
43Bernstein, 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
44Phillips, JS, Yung, MW, Burton, MJ, Swan, IR. Evidence review and ENT-UK consensus report for the use of aminoglycoside-containing ear drops in the presence of an open middle ear. Clin Otolaryngol 2007;32:330–6CrossRefGoogle ScholarPubMed
45Cooper, MA, Andrews, JM, Wise, R. Ciprofloxacin resistance developing during treatment of malignant otitis externa. J Antimicrob Chemother 1993;32:163–4CrossRefGoogle ScholarPubMed
46Hitchcock, CA, Pye, GW, Troke, PF, Johnson, EM, Warnock, DW. Fluconazole resistance in Candida glabrata. Antimicrob Agents Chemother 1993;37:1962–5CrossRefGoogle ScholarPubMed
47Tucker, ME. AAP policy limits fluoroquinolones to dire situations. Pediatric News 2006;40:1–2Google Scholar
48Forsythe, CT, Ernst, ME. Do fluoroquinolones commonly cause arthropathy in children? CJEM 2007;9:459–62CrossRefGoogle ScholarPubMed
49Paul, AC, Justus, A, Balraj, A, Job, A, Kirubakaran, CP. Malignant otitis externa in an infant with selective IgA deficiency: a case report. Int J Pediatr Otorhinolaryngol 2001;60:141–5Google Scholar
50Smart, K, Lemay, J-F, Kellner, JD. Antibiotic choices by paediatric residents and recently graduated paediatricians for typical infectious disease problems in children. Paediatr Child Health 2006;11:647–53Google ScholarPubMed