Malignant otitis externa or diabetic ear- Al Nahdha management protocol. Why it should be treated aggressively?

ABSTRACT

Malignant Otitis externa is an unusual but serious and potentially fatal condition. This is a study of 29 cases of malignant otitis externa admitted in our institution between January 1995 and December 2003. In this article a classification system defining the extent of disease, management protocol, indications for hyperbaric oxygen therapy, and overall effectiveness of treatment are reviewed. Correlating clinical, radiological, technetium 99 [Tc99] and gallium67 [Ga 67] scintigraphic findings and early therapeutic response, the disease was staged into stage I [mild], ll [moderate] and stage III [severe]. 15 patients of stage I disease were successfully treated with monodrug therapy- third generation cephalosporin [ceftazidime] only. Five patients of stage II disease were treated with parenteral ceftazidime and amikacin for 4-6 weeks. Of the remaining 9 cases with stage III disease, 6 were successfully treated with combination of antipseudomonal antibiotics [ceftazidime/ piperacillin and amikacin] for 8-12 weeks and adjuvant hyperbaric oxygen therapy. Site of granulations in the ear canal seems to be indicative of stage of the disease. 26 cases [89.7 percent] were treated successfully and are free of disease. Three patients [10.3 percent] died of disease recurrence. The presence of associated facial nerve involvement alone does not seem to be a poor prognostic sign. A new staging system is proposed and a guideline for therapy according to the stage of the disease is discussed