Algorithm for malignant otitis externa
Reviewed by Madhup Chaurasia

Timely detection and effective management of this potentially fatal condition cannot be overemphasised. This study presents 16 cases over 12 months in a tertiary referral centre. Most patients had diabetes and others were immunocompromised due to radiotherapy, immunosuppressive medication or acute myeloid leukaemia. Interestingly, no cranial nerve weakness was observed in any of these cases. Computed tomography (CT) and magnetic resonance imaging (MRI) formed the basis of diagnosis, supplemented with C-reactive protein (CRP), haemoglobin A1c levels and erythrocyte sedimentation rate (ESR) measurements, these also being used for monitoring the progress. Radionuclide scanning was not used for monitoring because of its high cost. The commonest infective organism was Pseudomonas aeruginosa. The antimicrobial therapy relied on tazocin with additional antibiotics and later, oral ciprofloxacin. Intravenous antibiotics were generally used for six weeks, extended if required. Based on this, the authors have worked out a useful algorithm involving multidisciplinary consultations. The publication includes comprehensive discussion and provides informative reading for this condition, which has been known to the author of this review to present in bizarre ways - once as ‘stroke’ with paralysis of lower cranial nerves and an ENT referral being made for dysphagia!

Malignant otitis externa, an increasing burden in the twenty-first century: review of cases in a UK teaching hospital, with a proposed algorithm for diagnosis and management.
Hutson KH, Watson GJ.
JOURNAL OF LARYNGOLOGY AND OTOLOGY
2019;133:356-62.