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

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.