Abstract

Malignant Otitis Externa (MOE) has shown a resurgent trend due to a rise in incidence of type 2 diabetes mellitus in developing countries like India. Classically, Pseudomonas aeruginosa has been implicated as the causative agent and empirical treatment involved Pseudomonas specific antibiotics. Recently, other microbiological agents and polymicrobial infections have been found to be associated with MOE.

Objective: To analyze the microbiological pattern of MOE and its impact on the treatment and outcome of the disease based on our ten years experience of managing this condition.

Methods: A retrospective study of all cases of MOE, treated at a tertiary referral hospital, between 2005-2015, was carried out. Details of patient histories, clinical assessment, management and outcomes were analyzed.

Results: In this study, 21 patients diagnosed with MOE, were included. All of them had poor glycemic control and the majority of them had deranged electrolyte levels (18/21) in addition to anemia (20/21). Pus culture from the external auditory meatus revealed different microorganisms, Pseudomonas Aeruginosa(6),  Staphylococcus aureus (3), polymicrobial(4), Enterococcus fecalis (1),Candida tropicalis(1). Control of the hyperglycemic status along with correction of electrolyte imbalance and culture directed parenteral antibiotics for a minimum period of 1 week resulted in 95% of patients recovering without sequelae.

Conclusion: Early diagnosis and aggressive management are essential for a satisfactory outcome. Parenteral and topical antibiotic therapy should be initiated keeping in mind the diverse microbiological spectrum encountered in this condition. A treatment protocol, specific to this region (tropics), has been developed by us and has proved successful.

Keywords: Malignant otitis externa, Skull base osteomyelitis, Pseudomonas aeruginosa, Staphylococcus aureus, polymicrobial infection, Diabetes mellitus, treatment protocol.

Anupma Jyoti Kindo

Department of Microbiology, Sri Ramachandra Medical College & Research Institute

Sri Ramachandra University, Porur, Chennai-600116 Tamil Nadu, India

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