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Malignant otitis externa

Definition

Malignant otitis externa is a disorder that involves infection and damage of the bones of the ear canal and at the base of the skull.

Alternative Names

Osteomyelitis of the skull; Otitis externa - malignant

Causes

Malignant otitis externa is caused by the spread of an outer ear infection (otitis externa) also called swimmer's ear. It is not common.

Risks for this condition include:

External otitis is often caused by bacteria that are hard to treat, such as pseudomonas. The infection spreads from the floor of the ear canal to the nearby tissues and into the bones at the base of the skull. The infection and inflammation may damage or destroy the bones. The infection may affect the cranial nerves, brain, or other parts of the body if continues to spread.

Symptoms

  • Ongoing drainage from the ear that is yellow or green and smells bad
  • Ear pain deep inside the ear. Pain may get worse when you move your head.
  • Hearing loss
  • Itching of the ear or ear canal
  • Fever
  • Trouble swallowing
  • Weakness in the face
  • Voice loss

Exams and Tests

Your health care provider will look into your ear for signs of an outer ear infection. The head around and behind the ear may be tender to touch. A nervous system (neurological) exam may show that the cranial nerves are affected.

If there is any drainage, the doctor may send a sample of it to the lab. The lab will culture the sample to try to find the cause of the infection.

To look for signs of a bone infection next to the ear canal, the following tests may be done:

Treatment

The goal of treatment is to cure the infection. Treatment often lasts for several months, because it is difficult to treat the bacteria and reach an infection in bone tissue.

You will need to take antibiotic medicines for a long period of time. The medicines may be given through a vein (intravenously), or by mouth. Antibiotics should be continued until scans or other tests show the inflammation has gone down.

Surgery to remove dead or damaged tissue (surgical debridement) in the skull may be needed in some cases.

Outlook (Prognosis)

Malignant otitis externa most often responds to long-term treatment, especially if treated early. It may return in the future. Severe cases may be deadly.

Possible Complications

  • Damage to the cranial nerves, skull, or brain
  • Return of infection, even after treatment
  • Spread of infection to the brain or other parts of the body

When to Contact a Medical Professional

Call your health care provider if:

  • You develop symptoms of malignant otitis externa
  • Symptoms continue despite treatment
  • You develop new symptoms

Go to the emergency room or call the local emergency number (such as 911) if you have:

Prevention

To prevent an external ear infection:

  • Dry the ear thoroughly after it gets wet.
  • Avoid swimming in polluted water.
  • Protect the ear canal with cotton or lamb's wool while applying hair spray or hair dye (if you are prone to getting external ear infections).
  • After swimming, place 1 or 2 drops of a mixture of 50% alcohol and 50% vinegar in each ear to help dry the ear and prevent infection.

Treat acute otitis externa completely. Do not stop treatment sooner than your health care provider recommends. Following your doctor's plan and finishing treatment will lower your risk of malignant otitis externa.

References

Guss J, Ruckenstein MJ. Infections of the external ear. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: Mosby Elsevier; 2010:chap 137.

O'Handley JG, Tobin EJ, Shah AR. Otorhinolaryngology. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 19.

Pfaff JA, Moore GP. Otolaryngology. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Mosby Elsevier; 2013:chap 72.


Review Date: 8/4/2014
Reviewed By: Ashutosh Kacker, MD, BS, Professor of Clinical Otolaryngology, Weill Cornell Medical College, and Attending Otolaryngologist, New York-Presbyterian Hospital, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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