ear, nose, and throat disorders
Malignant External Otitis
Treatment of Malignant External Otitis
Systemic antibiotics, typically a fluoroquinolone and/or an aminoglycoside/semisynthetic penicillin combination Topical antibiotic/corticosteroid preparations (eg,ciprofloxacin/dexamethasone) Rarely, surgical debridement Treatment of malignant external otitis is typically with a 6-week IV course of a culture-directed fluoroquinolone (eg,ciprofloxacin, 400 mg IV every 8 hours) and/or a semisynthetic penicillin (piperacillin–tazobactam or piperacillin)/aminoglycoside combination (forciprofloxacinresistantPseudomonas). However, mild cases may be treated with a high-dose oral fluoroquinolone (eg,ciprofloxacin, 750 mg orally every 12 hours) on an outpatient basis with close follow-up. Treatment also includes topicalciprofloxacin/dexamethasonepreparations (eg, ear drops, impregnated canal dressings) and serial debridement. Hyperbaric oxygen may be a useful adjunctive treatment, but its definitive role remains to be elucidated. Consultation with an infectious disease specialist for optimal antibiotic therapy and duration and with an endocrinologist for strict diabetic control is recommended. Extensive bone disease may require more prolonged antibiotic therapy. Meticulous control of diabetes is essential. Frequent office debridement is necessary to remove granulation tissue and purulent discharge. Surgery usually is not necessary, but surgical debridement to clear necrotic tissue may be used for more extensive infections ( Treatment reference ). 1.Al Araj MS, Kelley C: Malignant Otitis Externa. In: StatPearls (Internet). 2021; Treasure Island (FL): StatPearls Publishing: 2022 Jan PMID: 32310598. 