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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

Published online by Cambridge University Press:  12 April 2019

K H Hutson  and
G J Watson
K H Hutson
Affiliation:
Otolaryngology Head and Neck Department, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
G J Watson*
Affiliation:
Otolaryngology Head and Neck Department, Sheffield Teaching Hospitals NHS Foundation Trust, UK
*
Author for correspondence: Mr G J Watson, Otolaryngology Head and Neck Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK E-mail: glen.watson@sth.nhs.uk Fax: +44 (0)114 271 1985
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Abstract

Background

Malignant otitis externa is a potentially fatal infection of the skull base. With an ageing population and increasing prevalence of diabetes, the incidence of malignant otitis externa in the British population is rising. To date, there remain no accepted diagnostic criteria, few prognostic indicators and no consensus treatment pathways.

Method

A prospective case series was conducted at a tertiary referral teaching hospital.

Results

A cohort of susceptible individuals predominates (elderly, male, with immunosuppression and diabetes), with 25 per cent reporting a preceding incident. Otorrhoea, otalgia and canal granulation were the commonest presenting features, alongside positive pseudomonas cultures. No clear markers for predicating disease severity were isolated; however, a high initial haemoglobin A1c level demonstrated a significant moderately positive correlation with length of treatment.

Conclusion

A treatment pathway designed to provide a standardised approach to investigation and treatment is proposed, which aims to increase earlier diagnosis, streamline care and facilitate the development of best practice.

Keywords

Otitis ExternaPseudomonasDiabetes MellitusSkull Base
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 5 , May 2019 , pp. 356 - 362
Copyright
Copyright © JLO (1984) Limited, 2019 

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Footnotes

Mr G J Watson takes responsibility for the integrity of the content of the paper

Presented at the 31st Politzer Society meeting, 21–24 February 2018, Las Palmas de Gran Canaria, Spain.

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