Malignant otitis externa: Difference between revisions

Revision as of 19:47, 1 July 2020

Background

Otitis externa that is invasive into adjacent soft tissue and bone

Microbiology

Pseudomonas aeruginosa (95%), which is never a colonizer in this context
Staphylococcus aureus
Aspergillus species, rarely

Risk Factors

More common in patients with diabetes, immunocompromised patients, and frail elderly patients

Clinical Presentation

Severe pain and tenderness around the ear and mastoid process, plus purulent drainage from external ear canal
May spread to involve temporal bone, sigmoid sinuses, skull base, jugular vein, meninges, and brain
Can cause peripheral palsies of cranial nerves; most commonly VII, but also IX, X, and XII

Management

Clean and debride the ear canal
Systemic antibiotics as well as topical eardrops that include a corticosteroid
- Should be antipseudomonal, unless otherwise directed by cultures
- e.g. ceftazidime, cefepime, or piperacillin-tazobactam, with or without an adjunctive aminoglycoside
- Use of external eardrops is debated
Duration: up to 4-8 weeks if bony involvement seen on CT/MRI
For Aspergillus species, it is treated with voriconazole for at least 12 weeks

@@ Line 1: / Line 1: @@
-== Microbiology ==
+==Background==
+* [[Otitis externa]] that is invasive into adjacent soft tissue and bone
+===Microbiology===
-* [[Pseudomonas aeruginosa]] (95%)
+* [[Pseudomonas aeruginosa]] (95%), which is never a colonizer in this context
 * [[Staphylococcus aureus]]
+* [[Aspergillus species]], rarely
-* Others
-== Management ==
+===Risk Factors===
+* More common in patients with diabetes, immunocompromised patients, and frail elderly patients
+==Clinical Presentation==
-* Antipseudomonal antibiotic, unless otherwise directed by cultures
+* Severe pain and tenderness around the ear and mastoid process, plus purulent drainage from external ear canal
-* Duration: up to 4-6 weeks if bony involvement seen on CT/MRI
+* May spread to involve temporal bone, sigmoid sinuses, skull base, jugular vein, meninges, and brain
+* Can cause peripheral palsies of cranial nerves; most commonly VII, but also IX, X, and XII
+==Management==
+* Clean and debride the ear canal
+* Systemic antibiotics as well as topical eardrops that include a corticosteroid
+** Should be [[antipseudomonal]], unless otherwise directed by cultures
+** e.g. [[Is treated by::ceftazidime]], [[Is treated by::cefepime]], or [[Is treated by::piperacillin-tazobactam]], with or without an adjunctive aminoglycoside
+** Use of external eardrops is debated
+* Duration: up to 4-8 weeks if bony involvement seen on CT/MRI
+* For [[Aspergillus species]], it is treated with [[voriconazole]] for at least 12 weeks
 [[Category:Head and neck infections]]