Skip to main content

Advertisement

SpringerLink
Log in

The Role of Surgical Debridement in Cases of Refractory Malignant Otitis Externa

  • Original Article
  • Published:
Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Malignant Otitis externa is a necrotizing condition of external ear involving causing the osteomyelitis of the bone and surrounding soft tissue leading to multiple cranial nerve palsies. Though most patients respond to oral ciprofloxacin but due to emerging resistance cases of refractory malignant otitis externa which are unresponsive to antibiotic therapy for at least 6 weeks are being encountered lately. A study of 20 patients of refractory malignant otitis Externa was conducted at a tertiary care centre in north India; 10 patients were randomly allotted in group A and group B each. Group A was subjected to i/v ceftazidine 1 gm bd with oral ciprofloxacin 750 mg bd and Group B was subjected to surgical debridement with oral ciprofloxacin 750 mg bd. The improvement in symptoms was tabulated and statistical analysis was done using Mann–Whitney U test. There was better resolution of nocturnal pain in patients of group B who underwent surgical debridement although existing facial palsy didn’t improve in both the groups. The improvement of symptoms in group B was statistically significant with P ≤ 0.05. We strongly recommend the role of surgical debridement in cases of refractory malignant otitis externa to relieve the patient of nocturnal pain. As the sample size of the study is small we are looking forward to the compilation of a multi institutional data so that a consensus on definitive protocol in cases unresponsive to oral multidrug therapy can be established.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Carney SA, Gleeson M, Browning CG, Burton MJ, Clarke R et al (2008) Malignant otitis externa. Scott Brown’s otorhinolaryngology head and neck surgery, vol. 3, vol 7. Hodder Arnold, Great Britain, pp 3336–3340

    Book  Google Scholar 

  2. Bhandary S, Karki P, Sinha BK (2002) Malignant otitis externa: a review. Pac Health Dialog 9:64–67

    PubMed  Google Scholar 

  3. Chandler JR (1968) Malignant external otitis. Laryngoscope 78:1257–1294

    Article  CAS  Google Scholar 

  4. Mardinger O, Rosen D, Minkow B, Tulzinsky Z, Ophir D, Hirshberg A (2003) Temporomandibular joint involvement in malignant external otitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 96(398–403):4

    Google Scholar 

  5. Kwon BJ, Han MH, Oh SH, Song JJ, Chang KH (2006) MRI findings and spreading patterns of necrotizing external otitis: Is a poor outcome predictable? Clin Radiol 61(495–504):5

    Google Scholar 

  6. Joshua BZ, Sulkes J, Raveh E, Bishara J, Nageris BI (2008) Predicting outcome of malignant external otitis. Otol Neurotol 29:339–343

    Article  Google Scholar 

  7. Peleg U, Perez R, Raveh D, Berelowitz D, Cohen D (2007) Stratification for malignant external otitis. Otolaryngol Head Neck Surg 137(301–5):9

    Google Scholar 

  8. Lee JE, Song JJ, Oh SH, Chang SO, Kim CH, Lee JH (2011) Prognostic value of extension patterns on follow-up magnetic resonance imaging in patients with necrotizing otitis externa. Arch Otolaryngol Head Neck Surg 137(688–93):11

    Google Scholar 

  9. Amorosa L, Modugno GC, Pirodda A (1996) Malignant external otitis: review and personal experience. Acta Otolaryngol Suppl 521:3–16

    Article  CAS  Google Scholar 

  10. Somnath S et al (2013) Malignant otitis externa with bilateral cranial nerve involvement: report of a unique case. Indian J Otol 19(1):33–35

    Article  Google Scholar 

  11. Ganadhar S, Sreepada S, Kwartler J (2003) Skull base osteomyelitis secondary to malignant otitis externa. Curr Opin Otolaryngol Head Neck Surg 11:316–332

    Article  Google Scholar 

  12. Rutka J (2004) Acute otitis externa: treatment perspectives. Ear Nose Throat J 83(9 Suppl 4):20–21

    PubMed  Google Scholar 

  13. Grandis JR, Branstetter BF, Yu VL (2004) The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis 4:34–39

    Article  Google Scholar 

  14. Shamanna K, Ganga VB (2018) Changing trends in the management of malignant otitis externa: our experience. Res Otolaryngol 7(1):9–14

    Google Scholar 

  15. Stevens SM, Lambert PR, Baker AB, Meye YA (2015) Malignant otitis externa: a novel stratification protocol for predicting treatment outcomes. Otol Neurotol 36(9):1492

    Article  Google Scholar 

  16. Rubin J, Stoehr G, Yu VL, Muder RR, Matador A, Kamerer DB (1989) Efficacy of oral ciprofloxacin plus rifampin for treatment of malignant external otitis. Arch Otolaryngol Head Neck Surg 115:1063–1069

    Article  CAS  Google Scholar 

  17. Carlton DA, Perez EE, Smouha EE (2017) Malignant external otitis: the shifting treatment paradigm. Am J Otolaryngol. https://doi.org/10.1016/j.amjoto.2017.05.010

    Article  PubMed  Google Scholar 

  18. Soudry E, Hamzany Y, Preis M, Joshua B, Hadar T, Nageris BI (2011) Malignant external otitis: analysis of severe cases. Otolaryngol Head Neck Surg 144:758–762

    Article  Google Scholar 

  19. Soudry E, Joshua BZ, Sulkes J, Nageris BI (2007) Characteristics and prognosis of malignant external otitis with facial paralysis. Arch Otolaryngol Head Neck Surg 133:1002–1004

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sri Guru Ram Das Institute of Health Sciences and Research Amritsar, HIG 202, Sector 71, Mohali, 160071, India

    Jaskaran Singh

  2. Sri Guru Ram Das Institute of Health Sciences and Research Amritsar, 27-C; Sant Avenue, The Mall, Amritsar, 143001, India

    Bhanu Bhardwaj

Authors
  1. Jaskaran Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bhanu Bhardwaj
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bhanu Bhardwaj.

Ethics declarations

Conflict of interest

The author declares that they have no conflict of interest

Informed Consent

Before starting the study Ethical Clearance was taken from the institutional ETHICAL Committee as per DECLARATION OF HELSINKI

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Singh, J., Bhardwaj, B. The Role of Surgical Debridement in Cases of Refractory Malignant Otitis Externa. Indian J Otolaryngol Head Neck Surg 70, 549–554 (2018). https://doi.org/10.1007/s12070-018-1426-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12070-018-1426-0

Keywords

Search

Navigation