Malignant otitis externa in the antibiotic resistance era: key to successful treatment

Malignant otitis externa in the antibiotic resistance era: key to successful treatment. Objective: Malignant otitis externa (MOE) is a rare aggressive, necrotizing infection of the external auditory canal and the temporal bone. MOE may have a poor prognosis when it is not treated promptly and adequately. It is most commonly reported in males, older individuals, patients with diabetes, or patients that are immunocompromised. Pseudomonas aeruginosa is the main pathogenic agent involved. This study aimed to evaluate a clinical series of patients with MOE and discuss the current literature on the topic. Methodology: This retrospective study included 8 patients with MOE that were evaluated and treated, medically and/ or surgically, at the University Hospital of Ferrara between January 2012 and December 2016. We retrieved data from medical records on the clinical history, imaging, and treatment. Results: In all cases, a microbiological examination disclosed the presence of P. aeruginosa. The infection was eventually controlled in all cases, after a median of 6 months of therapy. All patients were followed-up for an average of 12 months after infection resolution. Conclusion: Currently, no specific guidelines for MOE treatment are available in the literature. Based on our findings, we proposed a diagnostic and therapeutic flow-chart for managing this infection.