Abstract
Introduction
Malignant otitis externa (MOE) is a progressive infection of the external auditory
canal (EAC). This disease is rare but has severe morbidity and mortality.
Objective
This narrative review provides an overview of malignant otitis externa for emergency
clinicians.
Discussion
MOE is an invasive external ear infection that spreads to the temporal bone and can
further progress to affect intracranial structures. Complications of advanced MOE
include cranial nerve involvement, most commonly the facial nerve, and intracranial
infections such as abscess and meningitis. The most common causative agent of MOE
is
Pseudomonas aeruginosa, but others include methicillin-resistant
Staphylococcus aureus and fungi. Major risk factors for MOE include diabetes mellitus, immunosuppression,
and advanced age. Red flags for MOE include severe otalgia (pain out of proportion
to exam) or severe otorrhea, neurologic deficits (especially facial nerve involvement),
previously diagnosed otitis externa not responsive to therapy, and patients with major
risk factors for MOE. Examination may show purulent otorrhea or granulation tissue
in the EAC, and culture of EAC drainage should be performed. Diagnosis is aided by
computed tomography (CT) with intravenous contrast, which may demonstrate bony destruction
of the temporal bone or skull base. When suspecting MOE, early consultation with an
otolaryngologist is recommended and antibiotics with pseudomonal coverage are needed.
Most patients with MOE will require admission to the hospital.
Conclusions
MOE is a rare, yet deadly diagnosis that must be suspected when patients with immunocompromise,
diabetes, or advanced age present with severe otalgia. Rapid diagnosis and treatment
may prevent complications and improve outcomes.
Keywords
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Article Info
Publication History
Published online: April 29, 2020
Accepted:
April 23,
2020
Received in revised form:
April 19,
2020
Received:
February 3,
2020
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
Published by Elsevier Inc.
