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Medical Science Monitor Basic Research


Malignant Otitis External: Our Experience and Literature Review

Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Patient complains / malpractice, Unexpected drug reaction , Educational Purpose (only if useful for a systematic review or synthesis)

Antonella M. Di Lullo, Camilla Russo, Piera Piroli, Alessandra Petti, Pasquale Capriglione, Elena Cantone, Gaetano Motta, Maurizio Iengo, Andrea Elefante, Michele Cavaliere

Italy Department of Neuroscience, Reproductive and Odontostomatological Sciences, Otorhinolaryngology – Head and Neck Surgery Unit, University of Naples Federico II, Naples, Italy

Am J Case Rep 2020; 21:e925060

DOI: 10.12659/AJCR.925060

Available online: 2020-06-30

Published: 2020-08-18


BACKGROUND: Malignant external otitis (MEO) is an invasive infection that can involve the external auditory canal and the skull base up to the contiguous soft tissues. Considering the changing face of MEO, we reviewed cases of MEO treated in our Ear Nose Throat (ENT) clinic - University Federico II of Naples between 2018 and 2019 to evaluate the current epidemiology of the condition and to assess the state of art on diagnosis, therapeutic and follow-up management in our patients.
CASE REPORT: We present the cases of three male patients with Type 2 diabetes mellitus who complained of long-lasting otorrhea and pain, with clinical suspicion of MEO. In all cases, ear swab was positive for Pseudomonas aeruginosa. All our patients received a 6-week course of intravenous ciprofloxacin, piperacillin, and tazobactam, with rapid clinical symptoms improvement and complete recovery at 1-year follow-up.
CONCLUSIONS: MEO is difficult to treat due to the lack of standardized care guidelines. Patients with MEO often present with severe otalgia, edema, otorrhea, and facial nerve paralysis. Clinicians must suspect MEO in elderly diabetic and immunocompromised patients with persistent otalgia after external otitis. Imaging (computed tomography and magnetic resonance imaging) can play synergistic roles in the management of MEO. To evaluate eradication of the disease, clinicians have to assess clinical symptoms and signs as well as radiological imaging and inflammatory markers.

Keywords: Brain Diseases, Magnetic Resonance Imaging, otitis externa, Tomography, Emission-Computed