Abstract
Purpose
Malignant otitis externa (MOE) is a rare form of invasive osteomyelitis of the external ear canal. It is typically caused by Pseudomonas aeruginosa in immunocompromised patients. The diagnosis is clinical, and the initial treatment involves systemic antibiotics or antifungal therapy. Surgery is usually only considered when medical treatment has failed. Although hyperbaric oxygen therapy (HBOT) is recommended for refractory osteomyelitis, there are no specific guidelines for MOE.
Methods
This is a retrospective study that evaluates clinical data, treatment, and results obtained in patients diagnosed with MOE treated with HBOT at the Pedro Hispano Hospital between 2007 and 2022.
Results
During the study period, fifteen patients diagnosed with MOE were admitted for treatment with HBOT. All patients received antibiotic and/or antifungal therapy, and three required surgical intervention before starting HBOT. The pathology was successfully managed on all patients.
Conclusions
HBOT may be an effective adjuvant treatment option in patients with MOE but it lacks robust scientific evidence. However, its therapeutic value should not be underestimated due to the good results and few adverse effects reported in recent retrospective studies and case reports.
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References
Cohen D, Friedman P (1987) The diagnostic criteria of malignant external otitis. J Laryngol Otol 101:216–221
Berenholz L, Katzenell U, Harell M (2002) Evolving resistant pseudomonas to ciprofloxacin in malignant otitis externa. Laryngoscope 112(9):1619–1622. https://doi.org/10.1097/00005537-200209000-00017
Franco-Vidal V, Blanchet H, Bebear C et al (2007) Necrotizing external otitis: a report of 46 cases. Otol Neurotol 28:771–773
Carfrae MJ, Kesser BW (2008) Malignant otitis externa. Otolaryngol Clin N Am 41:537–549
Amorosa L, Modugno GC, Pirodda A (1996) Malignant external otitis: review and personal experience. Acta Otolaryngol Suppl 116(521):3–16
Prasad SC, Prasad KC, Kumar A, Thada ND, Rao P, Chalasani S (2014) Osteomyelitis of the temporal bone: terminology, diagnosis, and management. J Neurol Surg B Skull Base 75(5):324–331
Byun YJ, Patel J, Nguyen SA, Lambert PR (2020) Hyperbaric oxygen therapy in malignant otitis externa: a systematic review of the literature. World J Otorhinolaryngol Head Neck Surg 7(4):296–302. https://doi.org/10.1016/j.wjorl.2020.04.002
Stokkel MP, Takes RP, van Eck-Smit BL, Baatenburg de Jong RJ (1997) The value of quantitative gallium-67 single-photon emission tomography in the clinical management of malignant external otitis. Eur J Nucl Med 24(11):1429–1432
Fernandes TD (2009) Medicina hiperbárica. Acta Med Port 22(4):323–334
McMonnies CW (2015) Hyperbaric oxygen therapy and the possibility of ocular complications or contraindications. Clin Exp Optom 98(2):122–125. https://doi.org/10.1111/cxo.12203. (Epub 2014 Oct 12)
Guerrero-Espejo A, Valenciano-Moreno I, Ramírez-Llorens R, Pérez-Monteagudo P (2017) Malignant external otitis in Spain. Acta Otorrinolaringol Esp 68(1):23–28. https://doi.org/10.1016/j.otorri.2016.02.010. (Epub 2016 May 27, in Spanish)
Amaro CE, Espiney R, Radu L, Guerreiro F (2019) Malignant (necrotizing) externa otitis: the experience of a single hyperbaric centre. Eur Arch Otorhinolaryngol 276(7):1881–1887. https://doi.org/10.1007/s00405-019-05396-7
Kaya İ, Sezgin B, Eraslan S, Öztürk K, Göde S, Bilgen C et al (2018) Malignant otitis externa: a retrospective analysis and treatment outcomes. Turk Arch Otorhinolaryngol 56(2):106–110. https://doi.org/10.5152/tao.2018.3075
Wood SJ, Kuzel TM, Shafikhani SH (2023) Pseudomonas aeruginosa: infections, animal modeling, and therapeutics. Cells 12(1):199. https://doi.org/10.3390/cells12010199
Al Siyabi A, Al Farsi B, Al-Shidhani A, Al Hinai Z, Al Balushi Y, Al QH (2023) Management of malignant otitis externa with hyperbaric oxygen therapy: a case series of 20 patients. Oman Med J 38(3):e512
Treviño González JL, Reyes Suárez LL, Hernández de León JE (2021) Malignant otitis externa: an updated review. Am J Otolaryngol 42(2):102894. https://doi.org/10.1016/j.amjoto.2020.102894. (Epub 2021 Jan 5)
Arsovic N, Radivojevic N, Jesic S, Babac S, Cvorovic L, Dudvarski Z (2020) Malignant otitis externa: causes for various treatment responses. J Int Adv Otol 16(1):98–103. https://doi.org/10.5152/iao.2020.7709
Carfrae MJ, Kesser BW (2008) Malignant otitis externa. Otolaryngol Clin N Am 41(3):537–549, viii–ix. https://doi.org/10.1016/j.otc.2008.01.004
Weaver LK (2014) Hyperbaric oxygen therapy indications. Undersea and Hyperbaric Medical Society
Mathieu D, Marroni A, Kot J (2017) Tenth European consensus conference on hyperbaric medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med 47(1):24
Jain K (2018) Textbook of hyperbaric medicine. Springer, Basel
Sabra RM, Taha MS, Khafagy AG et al (2015) The value of hyperbaric oxygen therapy in the management of malignant otitis externa patients. Egypt J Otolaryngol 31:143–148
Phillips JS, Jones SE (2013) Hyperbaric oxygen as an adjuvant treatment for malignant otitis externa. Cochrane Database Syst Rev 2013(5):CD00461
Plafki C, Peters P, Almeling M, Welslau W, Busch R (2000) Complications and side effects of hyperbaric oxygen therapy. Aviat Space Environ Med 71(2):119–124
Yamamoto Y, Noguchi Y, Enomoto M, Yagishita K, Kitamura K (2016) Otological complications associated with hyperbaric oxygen therapy. Eur Arch Otorhinolaryngol 273(9):2487–2493. https://doi.org/10.1007/s00405-015-3845-9. (Epub 2015 Dec 9)
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Gomes, P.M., Cabral, D.C., Costa, J.B. et al. Hyperbaric oxygen therapy in malignant otitis externa: a retrospective analysis. Eur Arch Otorhinolaryngol (2024). https://doi.org/10.1007/s00405-024-08734-6
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DOI: https://doi.org/10.1007/s00405-024-08734-6