Treatment
If you suspect malignant otitis externa arrange an urgent (same day) ear, nose, and throat (ENT) review (1,2)
- typically a computed tomography imaging scan is typically required (2)
- treatment includes:
- surgical debridement
- systemic antibiotics adequate to cover pseudomonal and staphylococcal infection, including methicillin- resistant S aureus
- consult local guidelines
- systemic antibiotics against Pseudomonas are required if malignant otitis externa is present, e.g. ciprofloxacin or ceftazidime, plus suitable anaerobic cover e.g. metronidazole
- biopsy may be necessary to detect neoplasia if the diagnosis of malignant otitis externa is uncertain or response to therapy is incomplete
References:
- Barry V et al. 10-Minute Consultation - Otitis externa. BMJ2021;372:n714http://dx.doi.org/10.1136/bmj.n714
- Rosenfeld RM, Schwartz SR, Cannon CR, etal. Clinical practice guideline: acute otitis externa.Otolaryngol Head Neck Surg2014;150(Suppl):S1-24.doi: 10.1177/0194599813517083 pmid: 24491310
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