title: Adjuvant hyperbaric oxygen in malignant external otitis.
abstract: Necrotizing invasive pseudomonal infection of the external auditory canal (malignant external otitis) is an uncommon but important disorder in the elderly. The high morbidity, and even mortality, of this disorder has been reduced by the early and intensive use of combination antipseudomonal antibiotics. However, in severely immunocompromised patients or in infection involving the base of the skull, multiple cranial nerves, or the meninges, conventional therapy has been prolonged, intensive, and relatively ineffective. We treated 16 patients with malignant external otitis with adjuvant hyperbaric oxygen therapy. In six patients, infection was in advanced stages, infections were recurrences after previous treatment, and repeated treatment with antipseudomonal antibiotics had failed. All 16 cases responded promptly when a 30-day course of hyperbaric oxygen was added to the antibiotic regimen, and all patients remained free of infection or neurologic deficit during 1 to 4 years of follow-up. No complications of this treatment modality were noted. Hyperbaric oxygen therapy reverses tissue hypoxia, which enhances phagocytic killing of aerobic microorganisms, and stimulates neomicroangiogenesis. In addition, hyperbaric oxygen augments the action of aminoglycoside antibiotics. Adjuvant hyperbaric oxygen therapy should be considered in advanced or recurrent cases of malignant external otitis.
authors.affiliation: Department of Hyperbaric Medicine, Southwest Texas Methodist Hospital.
authors.forename: J C
authors.initials: JC
authors.lastname: Davis
authors.forename: G A
authors.initials: GA
authors.lastname: Gates
authors.forename: C
authors.initials: C
authors.lastname: Lerner
authors.forename: M G
authors.initials: MG
authors.lastname: Davis
authors.forename: J T
authors.initials: JT
authors.lastname: Mader
authors.forename: A
authors.initials: A
authors.lastname: Dinesman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D008875:Middle Aged; D010032:Otitis Externa / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D011552:Pseudomonas Infections / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D011877:Radionuclide Imaging
chemical_list: D000900:Anti-Bacterial Agents