Malignant otitis externa is an inflammatory condition caused by Pseudomonas infection in elderly diabetic or immunosuppressed patients, presenting with excruciating ear pain, granulations in the ear canal, and potential facial or cranial nerve palsies from infection spread. Diagnosis involves severe otalgia, CT/MRI imaging, and Gallium67/Technetium99 scans. Treatment consists of controlling diabetes, ear canal cleaning, 6-8 weeks of IV antibiotics like Gentamicin + ticarcillin or third generation cephalosporins plus aminoglycosides, and potentially radical therapy or resection.

1. Malignant (necrotizing)
ootitis externa
Presented by:- Gauri Shankar Saini

2. • Inflammatory conditions caused by pseudomonas Infection
• in elderly diabetic
• in patients on immunosuppressive drugs
• Excruciating pain and granulations appearance in ear canal
• Facial paralysis
• Multiple cranial nerve palsy due to infection spread the skull base
and jugular foraman

3. Diagnosis
• Severe otalgia
• CT and MRI
• Gallium67 ( monitor disease)
• Technetium 99( monitor bone infection)

4. Treatment
• Control diabetes
• Toilet of ear canal
• Antibiotics for 6-8 weeks for pseudomonas aeruginosa
Gentamicin + ticarcillin (iv)
Third generation cephalosporin :- ceftriaxone (1-2g per
day/iv),ceftazidine (1-2 gm per day/iv) + aminoglycosides
Quinolones
• Radical therapy and resection