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Malignant Otitis Externa

  1. Definition:
    Progressive debilitating & sometimes fetal infection of the EAC,

    Soft tissues around and skull base (osteomyelitis of skull base)
  2. Features Occurs in
    1. Elderly
    2. Excruciating pain
    3. Diabetic
    4. Granulations in the meatus
    5. Immunosuppressed patient
    6. Facial N- paralysis
    7. Multiple CN- Palsies, Nerve commonly involved VII, IX, X, XI, XII
  3. Organism: Pseudomonas aeruginosa
  4. Microscopic feature: Necrotizing vasculitis
  5. Spread of the infection Middle cranial fossa
  6. Investigation:
    1. CT scan à Gallium scan for follow up to assess ¯ in inflammatory activity
    2. For initial diagnosis Technetium 99 scan picks up osteoblastic and osteoclastic activity even before structural always appear on CT. 
  7. Treatment: Includes three important parts.
    1. Control of diabetes
    2. Drug (Systemic as well as local)
      1. Oral Ciprofloxacin (1.5 g/day) *6-12 wks
      2. Other drugs:
        • ​​Tobramycin
        • Carbenicillin
        • Moxalactam
          Duration of treatment: 12 wks/ 3 months
    3. ​​Surgery
      1. Surgical debridement of the necrotic tissue.
      2. Radical mastoidectomy to be avoided if air cell system in not involved.

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