Malignant external otitis in elderly diabetic patients: Early detection, evaluation and follow-up

ABSTRACT

Twenty three cases of malignant external otitis were studied. A precipitating factor was recorded in 13 cases [56.5%]. Pseudomonas aeruginosa has been isolated uniformly in pure [78%] or mixed cultures. There is moderate to severe sensory neural hearing loss with more affection of the high frequencies. Histologically, there was non-specific infection. Roentenograhic findings are not helpfull in the early stages, but using isotope scanning can demonstrate the pathological changes. Gallium 67 scan was proved to have accurate ratio [100%] for early diagnosis, while Technetium 99 in MDP was proved to have the ability to assess the affection of the bone. The monitoring of response to therapy should be determined by gallium 67 scan which has as accuracy ratio of 100%. The treatment should be early and of aggressive interference, otherwise serious complications as facial nerve palsy which was recorded in 5 cases [35.7%] and paralysis of the last cranial nerve as occurred in 2 cases [14.3%]. Death occurred in 3 cases [21.4%]. The medical treatment was sufficient in the group of early detection; while in the group of late detection the best result was gained from the combination of early aggressive medical treatment in addition to local debridement of the external ear canal. Ciprofloxacin drug represents the future weapon for successful therapy