Malignant external otitis: Factors predicting patient outcomes.
OBJECTIVE
Malignant external otitis (MEO) is an aggressive infection, primarily affecting elderly diabetic patients. It begins in the external ear canal and spreads to adjacent structures. This study investigated the clinical characteristics of patients diagnosed and treated for MEO and analyzed factors affecting patient outcomes.


METHODS
Historical cohort.


METHODS
Tertiary medical center.


METHODS
Medical records of all patients diagnosed and treated for MEO from 1990 to 2013, were retrospectively reviewed. Clinical features, laboratory, imaging and outcomes were analyzed.


RESULTS
88 patients were included, mean age was 73±11.5years, 61 (69%) were male. Of these, 75% had diabetes. Mean follow-up was 60months. The most common presenting symptoms were otalgia (89%), external ear canal edema (86%) and otorrhea (84%). Pseudomonas aeruginosa was isolated in 61% of ear cultures. All patients were treated with antibiotics, 22% had surgery and 8% hyperbaric oxygen. Overall survival rate was 38% in 5years, with disease specific mortality 14%. DM, facial nerve palsy, positive CT scan and age above 70 were found to correlate and predict disease-specific mortality.


CONCLUSIONS
MEO carries a grave prognosis. The presence of two or more of the following features, DM, facial nerve palsy, positive CT scan and age above 70, predicts poor outcome, and highlights the need for prolonged, vigorous treatment.
Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: sagitst@clalit.org.il.
Sagit
S
Stern Shavit
Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Ethan
E
Soudry
Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Yaniv
Y
Hamzany
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel. Electronic address: bennyn@clalit.org.il.
Ben
B
Nageris
D000368:Aged; D000369:Aged, 80 and over; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010032:Otitis Externa / Q000175:diagnosis* / Q000453:epidemiology* / Q000382:microbiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate