MALIGNANT EXTERNAL OTITIS. A CASE SERIES FROM AN ITALIAN TERTIARY-CARE HOSPITAL

Abstract

Objectives: Malignant external otitis (MEO) is an. aggressive and potentially fatal disease that affects the external. auditory canal (EAC) it occurs almost exclusively in elderly, diabetic patients or immune compromised ones. The aim of this study was to describe epidemiological and clinical characteristics of a consecutive series of patients affected by malignant external otitis (MEO) and to conceive a flow-chart for its management. Material and methods: Adult patients diagnosed with and treated for MEO at the University Hospital of Messina, Italy between 2003 and 2013 were identified. Charts were reviewed for history, clinical presentation, laboratory data treatment, and outcomes. Results: Data of 11 patients were analyzed. Patients' mean age was 67.6 years; and ten were males. All but one suffered from diabetes and one was HIV infected. Average time of arrival at our department from onset of symptoms was 123 weeks. Intravenous antibiotics were administered in seven cases whereas exclusively oral antibiotics were given to four patients. Local antibiotic therapy was associated to systemic administration in seven cases. Four patients underwent surgical treatment. The median duration of antibiotic treatment was 12.4 weeks. Ten patients experienced a complete recovery even if in one of these residual facial palsy Was reported; one patient died Of a skull base Osteomyelitis with Multiple nerve involvement. A flow-chart which could guide physicians in the management of MEO is proposed. Conclusions. Malignant external otitis still remains today a very challenging issue Randomized clinical trials are needed to better clarify which Medical and surgical treatment could be the gold standard. A consensus diagnostic flow diagram could help in the management of this pathology.