A Study to Estimate the Variations in Management of Malignant Otitis Externa at Two Different Socio-Economic Hospitals
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Keywords

Malignant Otitis Externa
Pseudomonas Aeruginosa
Ciprofloxacin

How to Cite

1.
Saberwal A, Pusalkar A, Dabholkar Y. A Study to Estimate the Variations in Management of Malignant Otitis Externa at Two Different Socio-Economic Hospitals: A Clinical Dilemma. Integr J Med Sci [Internet]. 2020Aug.6 [cited 2020Sep.21];7. Available from: http://mbmj.org/index.php/ijms/article/view/193

Abstract

Introduction: Malignant otitis externa is an aggressive and potentially fatal infection of ear and skull base. Few studies have attempted to frame a protocol for management of this condition. However, the applicability of protocols involving radionuclide investigations in rural areas with restricted access is a challenge. Also, treatment with oral quinolones has since been threatened as their use has become widespread and indiscriminate. Objective: Owing to lack of standardized diagnostic criterion and treatment regimes, and growing concerns regarding quinolone resistance, we reviewed cases of malignant otitis externa treated across two different socio-economic centres to identify diagnostic and management difficulties. 
Methods: A retrospective data analysis of patients with malignant otitis externa managed in a tertiary and primary care hospital was done between December 2017 and November 2018. All relevant data was retrieved for assessment. 
Results: 43 patients were identified, out of these 19 were at the private institute and 24 at the charitable institute. Otalgia was the predominant symptom among all. Pseudomonas aeruginosa was the most commonly isolated organism (81% of patients). Ciprofloxacin resistance reported was 38%. The tertiary care institute used CT and Gallium scans for diagnosis, whereas primary centre employed clinical parameters and CT only. Treatment included Meropenem, Ceftazidime, Amikacin at tertiary centre and Ciprofloxacin and Streptomycin at primary centre.  
Conclusions: Incidence of Ciprofloxacin resistance was high in our study confirming the growing concern documented in other studies. Access to higher antibiotics was restricted in rural areas where Streptomycin was used in combination with other drugs with promising results.

https://doi.org/10.15342/ijms.7.193
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References

Grandis JR, Branstetter IV BF, Yu VL. The changing face of malignant (necrotising) external otitis: Clinical, radiological, and anatomic correlations. Lancet Infect Dis. 2004 Jan;4(1):34–9. DOI: 10.1016/s1473-3099(03)00858-2

Chandler JR. Malignant external otitis. Laryngoscope. 1968 Aug;78(8):1257–94. DOI: 10.1288/00005537-196808000-00002

Carfrae MJ, Kesser BW. Malignant otitis externa. Otolaryngol Clin North Am. 2008 Jun;41(3):537–49, viii–ix. DOI: 10.1016/j.otc.2008.01.004

Al-Noury K, Lotfy A. Computed tomography and magnetic resonance imaging findings before and after treatment of patients with malignant external otitis. Eur Arch Oto-Rhino-Laryngology. 2011 Dec 15;268(12):1727–34. DOI: 10.1007/s00405-011-1552-8

Okpala NCE, Siraj QH, Nilssen E, Pringle M. Radiological and radionuclide investigation of malignant otitis externa. J Laryngol Otol. 2005 Jan;119(1):71–5. DOI: 10.1258/0022215053222978

Hickey SA, Ford GR, O’Connor AF, Eykyn SJ, Sönksen PH. Treating malignant otitis with oral ciprofloxacin. BMJ. 1989 Aug;299(6698):550–1. DOI: 10.1136/bmj.299.6698.550

Levenson MJ, Parisier SC, Dolitsky J, Bindra G. Ciprofloxacin: drug of choice in the treatment of malignant external otitis (MEO). Laryngoscope. 1991 Aug;101(8):821–4. DOI: 10.1288/00005537-199108000-00004

Berenholz L, Katzenell U, Harell M. Evolving resistant pseudomonas to ciprofloxacin in malignant otitis externa. Laryngoscope. 2002 Sep;112(9):1619–22. DOI: 10.1097/00005537-200209000-00017

Hsu DI, Okamoto MP, Murthy R, Wong-Beringer A. Fluoroquinolone-resistant Pseudomonas aeruginosa: risk factors for acquisition and impact on outcomes. J Antimicrob Chemother. 2005 Apr;55(4):535–41. DOI: 10.1093/jac/dki026

Giamarellou H. Therapeutic guidelines for Pseudomonas aeruginosa infections. Int J Antimicrob Agents. 2000 Oct;16(2):103–6. DOI: 10.1016/s0924-8579(00)00212-0

Lucente FE, Parisier SC. James R. Chandler: “Malignant external otitis.” (Laryngoscope. 1968;78:1257-1294). Laryngoscope. 1996 Jul;106(7):805–7. DOI: 10.1097/00005537-199607000-00003

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