MALIGNANT EXTERNAL OTITIS - EXPERIENCE IN 12 CASES

Malignant external otitis is a life-threatening infection occurring in aging diabetic and immunocompromised patients. The development of new antimicrobial and diagnostic aids has modified the therapy and progno sis of the disease. We describe our experience in 12 cases seen betwee n 1982 and 1991, and review the diagnostic and therapeutic criteria du ring this lapse. Ten cases were males and 11 were diabetics. The most common symptoms were unilateral otalgia and otorrhea. All had edema of the external auditory channel and nine, proliferation of granulation tissue. Four had cranial nerve palsy. In ten patients Pseudomonas aeru ginosa was recovered. All had axial computed tomographic scans and six sequential radionuclide scanning performed at diagnosis and follow-up . Eleven patients recieved combined therapy with an aminoglucoside and an anti-pseudonomas beta-lactam antibiotic; in four ambulatory treatm ent was continued with a quinolone. Only one patient received a quinol one as only treatment due to unavailability of other drugs in the mexi can market. Presentation of granulation tissue or bone sequestrum was performed in nine patients. Only three required extensive surgical deb ridement procedures. We conclude that a combined antimicrobial therapy and the use of quinolones has favorably modified the prognosis and av oids extensive surgery and disminishes hospital stay.