Malignant Otitis Externa

Malignant otitis externa was first described as a severe infection of the external auditory canal [16]. It usually (but not always [101]) affects elderly diabetics, resulting in unremitting pain, purulent discharge and invasion of cartilage, nerve, bone and adjacent soft tissue. The causative agent is usually Pseudomonas aeruginosa, but other organisms including fungi have been incriminated. The condition frequently goes on to ninth, tenth, eleventh and twelfth cranial nerve palsies and meningitis and death may result.

Histopathological changes in the temporal bones of two patients who had been diagnosed clinically as having malignant otitis externa and were thought to have died of this condition [123] were those of severe otitis media and osteomyelitis of the jugular foramen secondary to it. It seems likely that the manifestations of malignant otitis media are due to the spread of inflammation from the tympanic cavity and mastoid air spaces to the petrous apex through bone marrow spaces by a process of osteomyelitis [85]. In recent years several patients with AIDS have been reported to have malignant otitis externa, and in one of them the presence of acute osteomyelitis of the skull base in addition supported the concept of osteomyelitis as the pathologic basis for malignant otitis externa put forward above [121].

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