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Malignant Otitis Externa by Dr.S .pptx
- 1. MALIGNANT OTITIS EXTERNA (NECROTIZING OTITISEXTERNA) BY DR. SRIHARIHARAN
- 2. OTITIS EXTERNA (OTO-EAR ITIS- INFLAMMATION) • Inflammation of the External auditory Canal • It can be acute or chronic, diffuse or localized • And can be caused by infection, allergy, irritation or Any Trauma
- 3. MALIGNANT OTITIS EXTERNA •It is an aggressive, inflammatory condition involving the outer ear canal progressively spreading to Involve skull base and the adjacent structures.
- 4. • Is itmalignancy – NO • Misnomer • It is so called malignancy because of aggressive & life- threatening clinical progressive behavior, Poor treatment outcome (in later stages) & high mortality rate MALIGNANT OTITIS EXTERNA
- 6. PREDISPOSING FACTORS- MOE •Elderly People with uncontrolled Diabetes mellitus • Immunocompromised (HIV) Patients • Patients on chemotherapy/ Immunosuppressive drugs
- 7. • Most commonorganism- Pseudomonas aeruginosa a gram negative bacteria
- 8. SIGNS AND SYMPTOMS SYMPTOMS •Excruciating ear pain (noctural) • Purulent Discharge from the ear • Hearing loss • Fever • Headache
- 9. SIGNS & SYMPTOMS •Also Facial palsy (VII CN) • Dysphagia (IX & X CN) • Loss of voice (X CN) Facial Palsy
- 10. SIGNS • Tragal sign– Positive • Granulations present in auditory canal- Pathognomonic of MOE SIGNS AND SYMPTOMS
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- 14. INVESTIGATIONS The initial investigationfor OME is • CT scan – Reveals the bony destruction but is often not helpful
- 15. INVESTIGATIONS • Technetium 99bone scan- reveals bone infection • But test remains positive for a year or so and cannot be used to monitor the disease.
- 16. INVESTIGATIONS • Gallium-67 ismore useful in diagnosis and follow-up of the patient. • It is taken up by monocytes and reticuloendothelial cells, and is indicative of soft tissue infection. • It can be repeated every 3 weeks to monitor the disease and response to treatment.
- 17. INVESTIGATIONS Further Hematological investigationsHelpful in further management and Treatment • Complete blood count • ESR ,CRP, Procalcitonin • FBS, PPBS, • HbAIC • Hearing test • Culture and sensitivity
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- 19. TREATMENT. • Toilet ofear canal Remove discharge, debris and granulations or any dead tissue or bone.
- 20. IV ANTIBIOTICS • Antibiotictreatment is continued for 6–8 weeks, sometimes more. • Third-generation cephalosporins e.g. ceftriaxone 1–2 g/day i.v. or ceftazidime 1–2 g/day i.v. are usually combined with an aminogly
- 21. ORAL ANTIBIOTICS • Quinolones(ciprofloxacin, ofloxacin and levofloxacin) are also effective and can be given orally. They can be combined with rifampin. • Ciprofloxacin 750 mg OD orally can be used.
- 22. HYPERBARIC OXYGEN THERAPY •HBO increases the partial pressure of oxygen improving hypoxia and allowing greater oxidative killing of bacteria. • Used only as an adjunct to antimicrobial therapy • Since the exact mechanism and success rate is very low, it is not widely used.
- 23. TREATMENT • Along withabove course of treatment, The primary goal is to control Diabetes In Diabetic patients (or to treat the Primary cause) • Prolonged antibiotic treatment has replaced radical surgery and resections done earlier for this condition
- 24. FOLLOW UP Response totreatment • Earliest sign of response to therapy is decrease in nocturnal ear pain • Drop in ESR,CRP & procalcitonin • Gallium -67/ PET scan after treatment (usually after 6-8 weeks), useful in follow-up course of Treatment
- 25. PREVENTION • Avoid manipulationof the ear canal in immunocompromised patients • Don't use cotton buds to clean ears • Avoid aural irrigation • Early diagnosis and treatmentnecessary • Strict control of primary condition • Regular follow up
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