[Malignant or necrotizing otitis externa: experience in 22 cases].
Malignant or progressive necrotizing otitis extrema is an uncommon but severe infectious condition of the external auditory canal. Over a period of four years, we treated 22 patients: 60% had diabetes (1/4 insulin dependent) and 13% were immunodepressed. The causal germ was Pseudomonas aeruginosa in 87% of cases. The pretherapeutic work-up included a computed tomography scan and a technetium scintigraphy to confirm diagnosis and assess extension. Repeated scintigraphies with gallium were used to follow the course under treatment. Medical treatment was used in most cases (16/22) with parenteral antibiotic therapy using a third-generation cephalosporin (ceftazidime or ceftriaxone) and a fluoroquinolone (ciprofloxacin or ofloxacin) and, if there was no contraindication, hyperbaric oxygen. Surgery is not indicated in malignant otitis externa. We had a 95% cure rate with only 10% recurrence. We reviewed the data in the literature on malignant otitis externa and present the important diagnostic, imaging and therapeutic aspects.
Martel
J
J
Service d'ORL et de chirurgie cervico-faciale, Service de médecine nucléaire, Hôpital Pellegrin C.H.U. de Bordeaux, 33076 Bordeaux Cedex.
Duclos
J Y
JY
Darrouzet
V
V
Guyot
M
M
Bébéar
J P
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D048909:Diabetes Complications; D018450:Disease Progression; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D024841:Fluoroquinolones; D005710:Gallium Radioisotopes; D006801:Humans; D006931:Hyperbaric Oxygenation; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D010032:Otitis Externa / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D013667:Technetium; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D002511:Cephalosporins; D024841:Fluoroquinolones; D005710:Gallium Radioisotopes; D013667:Technetium