Vol.103 No.1 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 103 No. 1 January 2010
Clinical Study of 5 Cases of Malignant External Otitis
Hiroyuki Mihashi, Tomoyuki Kurita, Yoshihisa Ueda,
Youichi Matsuda, Shinsuke Ito and Tadashi Nakashima
(Kurume University School of Medicine)
Malignant external otitis (MEO) is an uncommon, invasive and, sometimes, mortal disease that is mainly caused by pseudomonal infection of the external auditory canal. MEO frequently involves the base of the skull, multiple cranial nerves and the meninx. Recently, the mortality rate of this disease has decreased due not only to the use of antipseudomonal antibiotics, but also to the availability of Burow's solution and hyperbaric oxygen therapy (HBO). We have experienced 5 cases of MEO which were treated between 1999 and 2007 at Kurume University Hospital. All patients were male and their mean age was 73 year-old. As a complication, 4 cases had diabetes. Four cases had facial palsy due to MEO. All cases had received administration of antibiotics and an antifungal agent. Diabetic patients had been treated with insulin to control the blood sugar. Three patients had been treated with surgical debridement and the use of Burow's solution. In one case, MEO was well controlled with HBO and the intravenous administration of alprostadil alfadex (PGE1), but the recurrence was severe and the patient died. Despite combination treatment, four of the 5 cases died of meningitis due to MEO. In a patient with diabetes who was treated using Burow's solution, an antifungal agent, and insulin, the MEO was cured and the patient has been alive for 18 months. As a local treatment, Burow's solution is effective against MEO. As adjuvant treatments, HBO and administration of PGE1 may be effective against MEO.
Key words :malignant external otitis, Burow's solution, hyperbaric oxygen therapy, skull base
osteomyelitis