View source for Malignant otitis externa

==Background==
[[File:Gray907.png|thumb|Ear anatomy]]
*Life-threatening infection of external ear/canal, soft tissue, +/- spread to skull base
*Diabetes and immunosuppression are main risk factors
*Pseudomonas causes >90% of cases
*Begins as simple otitis externa

==Clinical Features==
===Adults===
*[[Otitis externa]] that has not resolved despite 2-3wks of topical antibiotics
*[[Otalgia]] often out of proportion for routine otitis externa
*Edema of external auditory canal
*Granulation tissue often seen in the ear canal floor
*Facial nerve often first CN involved<ref>Pfaff JA, Moore GP: Otolaryngology, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, Ch 72.</ref>
*[[cranial nerve palsies|CN IX, X, or XI involvement]]
*Trismus

===Pediatrics===
*More rapidly progressive than in adults
**[[Fever]], [[leukocytosis]], bacteremia/[[sepsis]]
*TM, middle ear, and facial nerve more likely to be affected

==Differential Diagnosis==
{{Ear DDX}}

==Evaluation==
[[File:PMC3292638 13244 2011 126 Fig5 HTML.png|thumb|Malignant external otitis. Axial CT scan in bone window demonstrates destruction of mastoid segment of petrous bone. There were also subtle cortical destructions visible in tympanic bone.]]
*Imaging<ref>Nussenbaum B et Al. Malignant Otitis Externa Workup. Medscape, Jul 14 2015. http://emedicine.medscape.com/article/845525-workup#c4</ref>
**Most authors support CT initially, but CT fails to diagnose early osteomyelitis since 30% bone destruction needed for detection
**MRI more sensitive for intracranial complications
*Labs
**WBC usually normal or slightly elevated
**Left shift uncommon
**Elevated ESR and CRP
***Differentiates from MOE from acute external otitis or malignancy
***However, not required for diagnosis<ref>Hosmer, K: Ear Disorders, in Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM (eds): Emergency Medicine, A Comprehensive Study Guide, ed 8. New York, McGraw-Hill, 2016, Ch 242:p 1581-2.</ref>

==Management==
===Adults===
*[[Antipseudomonal cephalosporin]] '''OR''' [[fluoroquinolone]]

===Peds===
*[[Imipenem]] '''OR''' ([[aminoglycoside]] + [[antipseudomonal penicillin]])

==Disposition==
*Contact ENT for disposition decision; early infection may be managed as outpatient

==Complications==
*Lateral or sigmoid sinus thrombosis
*[[Meningitis]]

==See Also==
*[[Otitis Externa]]
*[[Otitis Media (Peds)]]

==References==
<references/>


[[Category:ENT]]
[[Category:ID]]