TY - JOUR
T1 - An emergency medicine-focused review of malignant otitis externa
AU - Long, Drew A.
AU - Koyfman, Alex
AU - Long, Brit
N1 - Funding Information:
DL, AK, and BL conceived the idea for this manuscript and contributed substantially to the writing and editing of the review. We would like to thank Dr. David Talan for his contributions and for reviewing this manuscript prior to submission. This manuscript did not utilize any grants or funding, and it has not been presented in abstract form. Approval to submit this review to American Journal of Emergency Medicine was granted by Dr. J Douglas White. This clinical review has not been published, it is not under consideration for publication elsewhere, its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder. This review does not reflect the views or opinions of the U.S. government, Department of Defense, U.S. Army, U.S. Air Force, or SAUSHEC EM Residency Program.
Publisher Copyright:
© 2020
PY - 2020/8
Y1 - 2020/8
N2 - Introduction: Malignant otitis externa (MOE) is a progressive infection of the external auditory canal (EAC). This disease is rare but has severe morbidity and mortality. Objective: This narrative review provides an overview of malignant otitis externa for emergency clinicians. Discussion: MOE is an invasive external ear infection that spreads to the temporal bone and can further progress to affect intracranial structures. Complications of advanced MOE include cranial nerve involvement, most commonly the facial nerve, and intracranial infections such as abscess and meningitis. The most common causative agent of MOE is Pseudomonas aeruginosa, but others include methicillin-resistant Staphylococcus aureus and fungi. Major risk factors for MOE include diabetes mellitus, immunosuppression, and advanced age. Red flags for MOE include severe otalgia (pain out of proportion to exam) or severe otorrhea, neurologic deficits (especially facial nerve involvement), previously diagnosed otitis externa not responsive to therapy, and patients with major risk factors for MOE. Examination may show purulent otorrhea or granulation tissue in the EAC, and culture of EAC drainage should be performed. Diagnosis is aided by computed tomography (CT) with intravenous contrast, which may demonstrate bony destruction of the temporal bone or skull base. When suspecting MOE, early consultation with an otolaryngologist is recommended and antibiotics with pseudomonal coverage are needed. Most patients with MOE will require admission to the hospital. Conclusions: MOE is a rare, yet deadly diagnosis that must be suspected when patients with immunocompromise, diabetes, or advanced age present with severe otalgia. Rapid diagnosis and treatment may prevent complications and improve outcomes.
AB - Introduction: Malignant otitis externa (MOE) is a progressive infection of the external auditory canal (EAC). This disease is rare but has severe morbidity and mortality. Objective: This narrative review provides an overview of malignant otitis externa for emergency clinicians. Discussion: MOE is an invasive external ear infection that spreads to the temporal bone and can further progress to affect intracranial structures. Complications of advanced MOE include cranial nerve involvement, most commonly the facial nerve, and intracranial infections such as abscess and meningitis. The most common causative agent of MOE is Pseudomonas aeruginosa, but others include methicillin-resistant Staphylococcus aureus and fungi. Major risk factors for MOE include diabetes mellitus, immunosuppression, and advanced age. Red flags for MOE include severe otalgia (pain out of proportion to exam) or severe otorrhea, neurologic deficits (especially facial nerve involvement), previously diagnosed otitis externa not responsive to therapy, and patients with major risk factors for MOE. Examination may show purulent otorrhea or granulation tissue in the EAC, and culture of EAC drainage should be performed. Diagnosis is aided by computed tomography (CT) with intravenous contrast, which may demonstrate bony destruction of the temporal bone or skull base. When suspecting MOE, early consultation with an otolaryngologist is recommended and antibiotics with pseudomonal coverage are needed. Most patients with MOE will require admission to the hospital. Conclusions: MOE is a rare, yet deadly diagnosis that must be suspected when patients with immunocompromise, diabetes, or advanced age present with severe otalgia. Rapid diagnosis and treatment may prevent complications and improve outcomes.
KW - Diabetes mellitus
KW - Malignant otitis externa
KW - Necrotizing otitis externa
KW - Otalgia
KW - Otitis externa
KW - Pseudomonas
KW - Skull base osteomyelitis
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U2 - 10.1016/j.ajem.2020.04.083
DO - 10.1016/j.ajem.2020.04.083
M3 - Review article
C2 - 32505469
AN - SCOPUS:85085771996
SN - 0735-6757
VL - 38
SP - 1671
EP - 1678
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
IS - 8
ER -