Otitis Eksterna Maligna
Otitis Eksterna Maligna
Otitis Eksterna Maligna
Dr Manohar Suryawanshi
ENT Resident, INHS Asvini
• Anatomy
• Introduction
• Microbiology
• Pathogenesis
• Diagnosis
• Investigations
• Treatment
Introduction
Definition
• Aggressive and potentially life-threatening infection
of the soft tissues of the external ear and
surrounding structures, quickly spreading to involve
the periostium and bone of the skull base.
Microbiology:
• Diabetes mellitus
• Immuno-compromised status
Pathophysiology:
Osteitis ->Osteomyelitis
• Facial nerve (stylomastoid foramen) 60%
• IX, X and XI
• V and VI (petrous apex)
• Clivus and contralateral temporal bone can be
involved
• Infection can spread anteriorly into the sphenoid and
to the carotid
• Thrombosis of sigmoid sinus, IJV -> meningitis ->
cerebral abscess
• Haversian system of compact bone
• Headaches, fever
• Neck stiffness
• Clinical
• Biopsy
• ESR, CRP
Investigations:
• CT scan
• MRI
• Technetium-99m bone scan:
Osteoblastic activity
Highly sensitive for bony infection
• SPECT:
Good anatomic localization
Gallium scan:
therapy
technetium Tc 99m MDP bone scan
Clinicopathological classification
1 Clinical evidence of malignant otitis externa with
infection of soft tissues beyond the external auditory
canal, but negative Tc-99 bone scan
Medical
may be indicated
• Monotherapy with Ceftazidime
• Implantable gentamicin
• HBOT
Surgery:
• Wide resection:
Stylomastoid foramen
Jugular bulb
• Introduction of viable, vascularized tissue into the
bed
References
• Scott brown 7th edition
• Ballinger 16th edition
• Cummings 5th edition
• OCNA 2012
• Indian journal of nuclear medicine
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