International Journal of Medicine and Medical Sciences
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Article Number - B9FAA0D64801


Vol.9(7), pp. 86-91 , July 2017
DOI: 10.5897/IJMMS2017.1305
ISSN: 2006-9723



Full Length Research Paper

Malignant otitis externa: An assessment of emerging pathogens and the prognostic factors



Foster T. Orji
  • Foster T. Orji
  • Department of Otolaryngology, Faculty of Medical Sciences, University of Nigeria, Enugu Campus, Enugu State, Nigeria.
  • Google Scholar
James O. Akpeh
  • James O. Akpeh
  • Department of Otolaryngology, Faculty of Medical Sciences, University of Nigeria, Enugu Campus, Enugu State, Nigeria.
  • Google Scholar
Onyinyechi C. Ukaegbe
  • Onyinyechi C. Ukaegbe
  • Department of Otolaryngology, Faculty of Medical Sciences, University of Nigeria, Enugu Campus, Enugu State, Nigeria.
  • Google Scholar







 Received: 11 April 2017  Accepted: 30 May 2017  Published: 31 July 2017

Copyright © 2017 Author(s) retain the copyright of this article.
This article is published under the terms of the Creative Commons Attribution License 4.0


Although the mortalities from malignant otitis externa (MOE) have greatly reduced, it is still a potentially fatal clinical condition. This study was undertaken to review the treatment outcomes and prognostic factors in MOE and to compare the behavioral pattern of cases caused by pseudomonas and non-pseudomonas organisms. A retrospective chart review of patients diagnosed with MOE in a tertiary institution over a 13 year period was conducted. Treatment outcome was divided into survival and mortalities groups. Demographic and disease factors were analyzed regarding mortalities using univariate and multivariate analysis. Seventeen of 22 cases were analysed. Nine (53%) were diabetic while 5 were HIV positive. After average of 7 weeks of antibiotic therapy ± surgical debridement, the disease resolved in 59%. Mortality was 41%. Diagnostic delay, poor blood sugar control, and extensive disease were found to predict mortality (P = 0.051, 0.048, and 0.006 respectively). Age, sex, causative organism, HIV infection, facial nerve and other cranial involvement did not significantly predict mortality. Pseudomonas aeruginosa was isolated in 11 patients. The rest had atypical organisms, Staphylococcus aureus and Proteus spp. There was no significant difference in the disease extension, mortality, duration of treatment and facial nerve involvement between pseudomonas and non-pseudomonas groups. However the pseudomonas group were predominantly diabetic (p = 0.03). It is concluded that malignant otitis externa still has a significant mortality despite aggressive therapy. Extensive temporal bone/intracranial disease, poor blood sugar control, and diagnostic delay portend a poorer prognosis. S. aureus is an increasingly important causative organism in MOE especially in non-diabetic patients.

 

Key words: Malignant otitis externa, mortality, risk factors, causative organisms.

Benecke JE (1989). Management of osteomyelitis of the skull base. Laryngoscope 99:1220-1223.
Crossref

 

Berenholz L, Katzenell U, Harell M (2002). Evolving resistant pseudomonas to ciprofloxacin in malignant otitis externa. Laryngoscope 112:1619-1622.
Crossref

 
 

Chen YA, Chan KC, Chen CK, Wu CM (2011). Differential diagnosis and treatments of necrotizing otitis external: A report of 19 cases. Auris Nasus Larynx. 38:666-6670.
Crossref

 
 

Franco-Vidal V, Blanchet H, Bebear C, Dutronc H, Darrouzet V(2007). Necrotizing external otitis: A report of 46 cases. Otol. Neurotol. 28:771-773.
Crossref

 
 

Gehanno P (1994). Ciprofloxacin in the treatment of malignant external otitis. Chemotherapy. 40 Suppl 1:35-40.
Crossref

 
 

Guevara N, Mahdyoun P, Pulcini C, Raffaelli C, Gahide I, Castillo L(2013). Initial management of necrotizing external otitis: errors to avoid. Eur. Ann. Otorhinolaryngol. Head Neck Dis.130:115-21.
Crossref

 
 

Hobson CE, Moy JD, Byers KE, Raz Y, Hirsch BE, McCall AA (2014). Malignant otitis Externa:evolving pathogens and implications for diagnosis and treatment. Otolaryngol. Head Neck Surg. 151:112-116
Crossref

 
 

Joshua BZ, Sulkes J, Raveh E, Bishara J, Nageris BI (2008). Predicting outcome of malignant external otitis. Otol. Neurotol.29:339-343.
Crossref

 
 

Kwon BJ, Han MH, Oh SH, Song JJ, Chang KH (2006). MRI findings and spreading patterns of necrotizing external otitis: is a poor outcome predictable? Clin. Radiol. 61:495-504.
Crossref

 
 

Lasisi AO, Nwaorgu OGB (2001). Behavioural pattern of malignant otitis externa: 10-year review in Ibadan. Afr. J. Med. Med. Sci. 30:221-223.

 
 

Lee JE, Song JJ, Oh SH, Chang SO, Kim CH, Lee JH (2011). Prognostic value of extension patterns on follow-up magnetic resonance imaging in patients with necrotizing otitis externa. Arch. Otolaryngol. Head Neck Surg. 137:688-693.
Crossref

 
 

Loh S, Loh WS(2013). Malignant otitis externa: an Asian perspective on treatment outcomes and prognostic factors. Otolaryngol. Head Neck Surg. 148:991-996.
Crossref

 
 

Martel J, Duclos JY, Darrouzet V, Guyot M, Bébéar JP (2000). Malignant or necrotizing otitis externa: experience in 22 cases. Ann. Otolaryngol. Chir. Cervicofac. 117:291.

 
 

Nguyen LT, Harris JP, Nguyen QT (2010). Erosive external otitis: a novel distinct clinical entity of the external auditory canal in nonimmunosuppressed individuals. Otol. Neurotol. 31:1409-1411.
Crossref

 
 

Peleg U, Perez R, Raveh D, Berelowitz D, Cohen D (2007). Stratification for malignant external otitis. Otolaryngol Head Neck Surg.137:301-305.
Crossref

 
 

Pulcini C, Mahdyoun P, Cua E, Gahide I, Castillo L, Guevara N(2012). Antibiotic therapy in necrotising external otitis: case series of 32 patients and review of the literature. Eur. J. Clin. Microbiol. Infect. Dis. 31:3287-3294.
Crossref

 
 

Soudry E, Hamzany Y, Preis M, Joshua B, Hadar T, Nageris BI (2011). Malignant external otitis: analysis of severe cases. Otolaryngol. Head Neck Surg. 144:758-762.
Crossref

 
 

Soudry E, Joshua BZ, Sulkes J, Nageris BI(2007). Characteristics and prognosis of malignant external otitis with facial paralysis. Arch. Otolaryngol. Head Neck Surg.133:1002-1004.
Crossref

 
 

Stevens SM, Lambert PR, Baker AB, Meyer TA (2015). Malignant Otitis Externa: A Novel Stratification Protocol for Predicting Treatment Outcomes. Otol. Neurotol. 36:1492-1498.
Crossref

 
 

Walton J, Coulson C (2014). Fungal malignant otitis externa with facial nerve palsy: tissue biopsy AIDS diagnosis. Case Rep. Otolaryngol. 2014:192318.
Crossref

 

 


APA Orji, F. T., Akpeh, J. O., & Ukaegbe, O. C. (2017). Malignant otitis externa: An assessment of emerging pathogens and the prognostic factors. International Journal of Medicine and Medical Sciences, 9(7), 86-91.
Chicago Foster T. Orji, James O. Akpeh and Onyinyechi C. Ukaegbe. "Malignant otitis externa: An assessment of emerging pathogens and the prognostic factors." International Journal of Medicine and Medical Sciences 9, no. 7 (2017): 86-91.
MLA Foster T. Orji, James O. Akpeh and Onyinyechi C. Ukaegbe. "Malignant otitis externa: An assessment of emerging pathogens and the prognostic factors." International Journal of Medicine and Medical Sciences 9.7 (2017): 86-91.
   
DOI 10.5897/IJMMS2017.1305
URL http://academicjournals.org/journal/IJMMS/article-abstract/B9FAA0D64801

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