Malignant otitis externa: Difference between revisions
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* [[Pseudomonas aeruginosa]] (95%), which is never a colonizer in this context |
* [[Pseudomonas aeruginosa]] (95%), which is never a colonizer in this context |
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* [[Staphylococcus aureus]] |
* [[Staphylococcus aureus]] |
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* [[Aspergillus |
* [[Aspergillus]], rarely |
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===Risk Factors=== |
===Risk Factors=== |
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* More common in patients with diabetes, immunocompromised patients, and frail elderly patients |
* More common in patients with diabetes, immunocompromised patients, and frail elderly patients |
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==Clinical |
==Clinical Manifestations== |
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* Severe pain and tenderness around the ear and mastoid process, plus purulent drainage from external ear canal |
* Severe pain and tenderness around the ear and mastoid process, plus purulent drainage from external ear canal |
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* May spread to involve temporal bone, sigmoid sinuses, skull base, jugular vein, meninges, and brain |
* May spread to involve temporal bone, sigmoid sinuses, skull base, jugular vein, meninges, and brain |
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** Use of external eardrops is debated |
** Use of external eardrops is debated |
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* Duration: up to 4-8 weeks if bony involvement seen on CT/MRI |
* Duration: up to 4-8 weeks if bony involvement seen on CT/MRI |
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* For [[Aspergillus |
* For [[Aspergillus]], it is treated with [[voriconazole]] for at least 12 weeks |
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[[Category:Head and neck infections]] |
[[Category:Head and neck infections]] |
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Latest revision as of 20:12, 26 January 2022
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, rarely
Risk Factors
- More common in patients with diabetes, immunocompromised patients, and frail elderly patients
Clinical Manifestations
- 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, it is treated with voriconazole for at least 12 weeks
