What's the Diagnosis? By Dr. Jillian Smith

A 61 yo female with a history of DM presents with 3 days of severe R ear pain. She denies fever, but reports fullness, swelling and decreased hearing. Exam reveals significant swelling and tenderess of the R pinna and EAC without drainage. A CT is obtained. What's the diagnosis?   (scroll down for answer)





Answer:  Malignant Otitis Externa

  • infection of the external auditory canal and skull base
  • begins as otitis externa and progresses into osteomyelitis of temporal bone
  • most commonly due to Pseudomonas aeruginosa, less likely fungal secondary to aspergillosis
  • typically seen in elderly patients with DM or immunocompromised patients
  • presenting symptoms include: severe otalgia, otorrhea, sense of fullness, and hearing loss
  • exam findings include a swollen, tender external auditory canal, purulent otorrhea, and cranial nerve palsy (in more advanced infection)
  • CT temporal bones can be used to evaluate extent of infection
  • treatment includes a fluoroquinolone or an antipseudomonal cephalosporin