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Malignant otitis externa

Osteomyelitis of the skull; Otitis externa - malignant

 

Malignant otitis externa is a disorder that involves infection and damage of the bones of the ear canal and at the base of the skull.

Causes

 

Malignant otitis externa is caused by the spread of an outer ear infection (otitis externa) also called swimmer's ear. It is not common.

Risks for this condition include:

  • Chemotherapy
  • Diabetes
  • Weakened immune system

External otitis is often caused by bacteria that are hard to treat, such as pseudomonas. The infection spreads from the floor of the ear canal to the nearby tissues and into the bones at the base of the skull. The infection and swelling may damage or destroy the bones. The infection may affect the cranial nerves, brain, or other parts of the body if it continues to spread.

 

Symptoms

 

Symptoms include:

  • Ongoing drainage from the ear that is yellow or green and smells bad.
  • Ear pain deep inside the ear. Pain may get worse when you move your head.
  • Hearing loss .
  • Itching of the ear or ear canal.
  • Fever.
  • Trouble swallowing.
  • Weakness in the muscles of the face.

 

Exams and Tests

 

Your health care provider will look into your ear for signs of an outer ear infection. The head around and behind the ear may be tender to touch. A nervous system (neurological) exam may show that the cranial nerves are affected.

If there is any drainage, the provider may send a sample of it to the lab. The lab will culture the sample to try to find the cause of the infection.

To look for signs of a bone infection next to the ear canal, the following tests may be done:

  • CT scan of the head
  • MRI scan of the head
  • Radionuclide scan

 

Treatment

 

The goal of treatment is to cure the infection. Treatment often lasts for several months, because it is difficult to treat the bacteria and reach an infection in bone tissue.

You will need to take antibiotic medicines for a long period of time. The medicines may be given through a vein (intravenously), or by mouth. Antibiotics should be continued until scans or other tests show the inflammation has gone down.

Surgery to remove dead or damaged tissue (surgical debridement) in the skull may be needed in some cases.

 

Outlook (Prognosis)

 

Malignant otitis externa most often responds to long-term treatment, especially if treated early. It may return in the future. Severe cases may be deadly.

 

Possible Complications

 

Complications may include:

  • Damage to the cranial nerves, skull, or brain
  • Return of infection, even after treatment
  • Spread of infection to the brain or other parts of the body

 

When to Contact a Medical Professional

 

Call your provider if:

  • You develop symptoms of malignant otitis externa.
  • Symptoms continue despite treatment.
  • You develop new symptoms.

Go to the emergency room or call the local emergency number (such as 911) if you have:

  • Convulsions
  • Decreased consciousness
  • Severe confusion
  • Facial weakness, loss of voice, or difficulty swallowing associated with ear pain or drainage

 

Prevention

 

To prevent an external ear infection:

  • Dry the ear thoroughly after it gets wet.
  • Avoid swimming in polluted water.
  • Protect the ear canal with cotton or lamb's wool while applying hair spray or hair dye (if you are prone to getting external ear infections).
  • After swimming, place 1 or 2 drops of a mixture of 50% alcohol and 50% vinegar in each ear to help dry the ear and prevent infection.

Treat acute otitis externa completely. Do not stop treatment sooner than your provider recommends. Following your provider's plan and finishing treatment will lower your risk of malignant otitis externa.

 

 

Open References

References

Brant JA, Rickenstein MJ. Infections of the external ear. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 137.

Pfaff JA, Moore GP. Otolaryngology. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 72.

 
  • Ear anatomy

    Ear anatomy - illustration

    The ear consists of external, middle, and inner structures. The eardrum and the 3 tiny bones conduct sound from the eardrum to the cochlea.

    Ear anatomy

    illustration

    • Ear anatomy

      Ear anatomy - illustration

      The ear consists of external, middle, and inner structures. The eardrum and the 3 tiny bones conduct sound from the eardrum to the cochlea.

      Ear anatomy

      illustration

    A Closer Look

     

      Talking to your MD

       

        Tests for Malignant otitis externa

         
           

          Review Date: 5/25/2016

          Reviewed By: Sumana Jothi, MD, specialist in laryngology, Assistant Clinical Professor, UCSF Otolaryngology, NCHCS VA, SFVA, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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