treatment

Last edited 04/2021 and last reviewed 07/2021

If you suspect malignant otitis externa arrange an urgent (same day) ear, nose, and throat (ENT) review (1,2)

• typically a computed tomography imaging scan is typically required (2)
• treatment includes:
  • surgical debridement
  • systemic antibiotics adequate to cover pseudomonal and staphylococcal infection, including methicillin- resistant S aureus
    • consult local guidelines
    • systemic antibiotics against Pseudomonas are required if malignant otitis externa is present, e.g. ciprofloxacin or ceftazidime, plus suitable anaerobic cover e.g. metronidazole
  • biopsy may be necessary to detect neoplasia if the diagnosis of malignant otitis externa is uncertain or response to therapy is incomplete

Reference:

• Barry V et al. 10-Minute Consultation - Otitis externa. BMJ2021;372:n714http://dx.doi.org/10.1136/bmj.n714
• Rosenfeld RM, Schwartz SR, Cannon CR, etal. Clinical practice guideline: acute otitis externa.Otolaryngol Head Neck Surg2014;150(Suppl):S1-24.doi: 10.1177/0194599813517083 pmid: 24491310