Malignant otitis externa in a healthy non-diabetic patient

Abstract

A healthy 60-year-old male was initially treated for external otitis, and subsequently received multiple surgeries including abscess drainage, temporal bone debridement, canaloplasty of the external auditory meatus, and fistula excision and was treated with numerous antibiotics at another hospital over a 1-year period. He was seen at our hospital on February 14, 2014 with a complaint of a non-healing wound behind the left ear and drainage of purulent fluid. He had no history of diabetes mellitus or compromised immune function. Computed tomography (CT) and magnetic resonance imaging (MRI) studies at our hospital showed osteomyelitis involving the left temporal, occipital, and sphenoid bones, the mandible, and an epidural abscess. Routine blood testing and tests of immune function were normal, and no evidence of other infectious processes was found. He was diagnosed with malignant otitis externa (MOE). Bone debridement and incision and drainage of the epidural abscess were performed, and vancomycin was administered because culture results revealed Corynebacterium jeikeium, Corynebacterium xerosis, and Enterococcus faecalis. MOE should be considered in healthy patients with external otitis who fail initial treatment.

Cotton bud in external ear canal causing necrotising otitis externa and subdural abscess

“…Another previously described case of NOE complicated by cerebral abscess was successfully treated with extensive surgical debridement and abscess drainage, although this was in an older (60-year-old) patient with diabetes 9. Similarly, aggressive treatment was successful in a healthy 60-year-old man free of diabetes and immunocompromise who developed NOE complicated by epidural abscess 10…”

A Unique Case of Malignant Otitis Externa

“…Sami Horani, BS 1 , Shiva P. Daram, MD, MBA 2 , Gopi Shah, MD 3,4 , and Ron B. Mitchell, MD 3,4 A 11-year-old male presented to the hospital with a 2-day history of right otalgia, purulent otorrhea, and swelling after hot tub exposure. There was no significant medical, family, or social history.…”

“…3 However, there have been selective cases of MOE in immunocompetent adults. 4,5 Pseudomonas aeruginosa is causative in over 90% of cases, but Staphylococci, Streptococci, and gram-negative bacteria have also been implicated. 2,6 Recent studies on MOE have reported increased pathogen diversity.…”

Descriptive study on malignant otitis externa in diabetic patients at a tertiary care hospital at Madurandhagam

“…Local treatment (with removal of bone sequestered) and treatment with systemic antibiotics conferring to the outcomes of bacteriological tests (aminoglycosides, semisynthetic penicillins, third-and fourth generation cephalosporins, fluoroquinolones) are usually accepted. 9 Principal treatment of MOE comprises management of pain, removal of debris in the external auditory canal (EAC), topical medication administration for controlling edema and infection and prevention of contributing aspects. Treatments of topical antimicrobials result in a higher cure rate than placebo, and preparations of corticosteroid lessen swelling, secretions and erythema.…”