Malignant External Otitis in Nondiabetic Patients

Abstract

The purpose of this study is to point out that contrary to traditional belief, there is a small but significant group of nondiabetic patients with malignant external otitis. Thirty patients with a diagnosis of malignant external otitis were treated and followed up at the Department of Otolaryngology-Head and Neck Surgery, Beilinson Medical Center, between 1987 and 1991. Nine of these patients did not have clinical or laboratory evidence of diabetes. This study analyzes this group and concludes that the diagnosis of malignant external otitis should be considered by the treating physician in nondiabetic patients presenting with a Pseudomonas aeruginosa infection of the external ear canal. Severe pain and edematous closure of the canal, together with typical granulation tissue and failure to respond to medical treatment, are specific characteristics of this group.

Predicting Outcome of Malignant External Otitis

“…Our literature review yielded many studies of MEO from Israel with large series of patients (4,5,7,10,12,13,16), evidence to the comparably higher prevalence of the disease in our country. This might be explained by the warm and humid climate in this country, typical of the Middle East.…”

Malignant External Otitis: Review and Personal Experience

“…Although diabetes mellitus, advanced age and debilitated conditions are present in the vast majority of cases, not all authors consider these to be essential factors of the disease (6, 11,12). On microbiological grounds, most authors (5, 6, 11) agree that while isolation of Pseudornonas aeruginosa in the EAC strongly suggests MEO, it cannot be considered an Corey et ul., 1985 (15) At least 3 of 5 of the following signs and symptoms: 1) Persistent external otitis; 2) Granulation tissue in the EAC; 3) Evidence of mastoiditis or osteomyelitis of the skull base by radiograph or biopsy; 4) Cranial nerve paralysis; 5 ) Isolation of P. aevuginosa from the EAC or deeper skull site.…”

Otitis externa necroticans

“…Betroffen sind dabei in erster Linie ältere Männer mit Diabetes mellitus [12,14,18]. Allerdings sind in Abweichung von der Definition der Erkrankung auch Fälle bei Nichtdiabetikern mit Immundefekten beobachtet worden [1,29,30].…”