Malignant Otitis Externa: Evolving Pathogens and Implications for Diagnosis and Treatment

Background: Otitis externa is an inflammatory in external auditory canal, with the presentation of otalgia, otorrhea, and pruritus. Bacteria and fungi are the most causative agents of the disease. Although several antifungal and antibacterial agents are usually used to treat it, combination therapy plays an important role in good treatment efficacy. Objectives: According to the problems associated with the treatment of mixed otitis externa, the current study aimed at evaluating the efficacy of ceftazidime powder and topical miconazole (as the case group) versus topical miconazole only (as the control group) to treat mixed otitis externa. Methods: Seventy-two patients with mixed otitis externa were divided into two groups; the case group was treated with ceftazidime powder and topical miconazole, and the control group was treated only with topical miconazole. Both groups were evaluated after two weeks. The diagnosis of mixed otitis externa was based on signs, symptoms, and the presence of bacterial and fungal elements in direct examination and culture. Results: Swelling, itching, and canal discharge were observed in 67.7%, 64.7%, and 90.3% of the patients, respectively in the case group, and 47.1%, 26.3% and 93.1% of the patients, respectively in the control group. Complete resolution of all clinical signs and symptoms occurred in 23 (67.6%) patients in the case group and 11 (28.9%) patients in the control group (P = 0.001). Staphylococcus epidermidis and Pseudomonas aeruginosa were the most common bacteria, and Aspergillus spp. and Candida spp. were the most common fungi identified in the cultures. Conclusions: According to the complete resolution of clinical signs, the application of ceftazidime powder and topical miconazole was better than topical miconazole to treat mixed otitis externa.

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“…and Aspergillus niger, respectively (12,13). Several therapeutic regimens are employed to treat otitis externa (14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Treatment of Mixed Otitis Externa Using Ceftazidime Powder and Topical Miconazole Versus Topical Miconazole Only

Kiakojuri

Omran

Elahi

et al. 2018

Jundishapur J Microbiol

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“…Our search of the literature yielded only one other U.S. study examining the epidemiology of MRSA otitis: a 2014 study from Pittsburg Medical Center, which reported an MRSA rate of 15% among malignant otitis externa cases caused by S. aureus . 4 These findings may indicate that MRSA AOE, when not identified and treated early, may more frequently result in advanced disease and complications.…”

Section: Discussionmentioning

confidence: 99%

“… 2 , 3 S. aureus is thought to be the second most common pathogen in acute bacterial otitis externa, with case series identifying S. aureus in up to 40% of cases. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 Studies from Pakistan, Korea and New Zealand found rates of S. aureus AOE above 30%, 10 , 11 , 12 while the most recent study in the U.S. reported rates of 7.8%. 3 …”

Section: Introductionmentioning

confidence: 99%

Methicillin‐resistant Staphylococcus aureus in acute otitis externa

Duarte

Kozin

Bispo

et al. 2018

World j. otorhinolaryngol.-head neck surg.

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ObjectiveOtologic methicillin-resistant Staphylococcus aureus (MRSA) infection has historically been rare, but given the rise in community-acquired MRSA carriage and infection at other body sites, prevalence rates may be changing. The goal of this study was to determine the prevalence of MRSA in recent otologic cultures from patients with acute otitis externa (AOE).Study designRetrospective review of an institutional microbiologic database.MethodsA retrospective analysis was performed on serial culture isolates taken from the ear at a quaternary care hospital from January 2014 to April 2016. The causative pathogen and antibiotic sensitivity was determined by culture isolation and end point mean inhibitory concentration (MIC) testing. Medical records were reviewed to document patient characteristics, chronicity of infection, symptomatology, and previous treatments.ResultsOver the study period, 173 patients were diagnosed with AOE and underwent otologic cultures of the ear. Fifty-three (30.6%) of cultures grew S.aureus (SA). Of SA infections, 15 (28.3%) were identified as MRSA. MRSA patients were typically older than patients with methicillin-sensitive SA (MSSA) (mean age 46.7 ± 17.9 vs 29 ± 19.4, P = 0.003) and had more medical comorbidities (4 vs 1.7, P = 0.001). Compared to patients with MSSA, patients with MRSA were significantly more likely to have had prior ototopical antibiotic exposure (37% vs 73%, P = 0.019).ConclusionContemporary ear culture isolates at quaternary care center show higher rates of MRSA compared to historical reports in the literature. Clinicians should consider ear cultures to identify MRSA AOE.Level of EvidenceIV.

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“…Like in the index case, it is seen commonly in elderly male diabetics in their VI and VII decade of life ( Blyth et al., 2011 ; Das et al., 2019 ; Lee et al, 2008, 2017). Pseudomonas aeruginosa is the commonly isolated organism, representing more than 50% in most of the series, followed by methicillin-resistant Staphylococcus aureus and Klebsiella pneumonia ( Chen et al., 2010 ; Ali et al., 2010 ; Loh and Loh, 2013 ; Stern Shavit et al., 2016 ; Lee et al, 2008, 2017; Hobson et al., 2014 ; Le Clerc et al., 2014 ). Though the causative organism was identified to be Pseudomonas in our case, the culture reports may not always yield positive results ( Ali et al., 2010 ; Loh and Loh, 2013 ; Lee et al, 2008, 2017; Spielmann et al., 2013 ; Le Clerc et al., 2014 ; Sokołowski et al., 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Malignant otitis externa with subsequent internal jugular vein thrombosis and hypoglossal palsy: a report and review of literature

Devaraja

Nayak

2020

Journal of Otology

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Inflammation of a part or whole of the temporal bone and surrounding soft tissue is termed as malignant otitis externa, which typically spreads to skull base to involve cranial nerves VII. Rarely can it also effect one or more of cranial nerves IX, X, XI, and XII. We present a case of malignant otitis externa which presented with symptomatic palsy of IX and XII nerves sparing the VII cranial nerve. The patient though later on had internal jugular vein thrombosis, which we presume is due to the involvement of the parapharyngeal space that prompted us to reconsider the diagnosis, and later on, to aggravate the therapy. With proper blood sugar control and appropriate long term antibiotics, not only that the patient is disease free at one year follow up, but the cranial nerve deficits also recovered. Apart from sharing the clinical and management details of this patient, we have reviewed the relevant literature in the discussion, which has shed some light onto some of the interesting facts about this condition and its prognosis.

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Malignant Otitis Externa: Evolving Pathogens and Implications for Diagnosis and Treatment

Abstract: A high index of suspicion for nonpseudomonal organisms should be maintained in patients with signs and symptoms of MOE, especially in those without diabetes. MRSA is an increasingly implicated organism in MOE.

Cited by 67 publications

References 16 publications

Treatment of Mixed Otitis Externa Using Ceftazidime Powder and Topical Miconazole Versus Topical Miconazole Only

Treatment of Mixed Otitis Externa Using Ceftazidime Powder and Topical Miconazole Versus Topical Miconazole Only

Methicillin‐resistant Staphylococcus aureus in acute otitis externa

Malignant otitis externa with subsequent internal jugular vein thrombosis and hypoglossal palsy: a report and review of literature

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