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Malignant otitis externa: patient demographics and outcomes Introduction: Malignant otitis externa (MOE) is considered a disease of elderly diabetic patients where pseudomonas is the most prevalent causative organism, however there is limited evidence in the literature to support this. This study aimed to provide evidence to substantiate these assumptions.
Methods: Patients were identified through clinical coding. MOE was confirmed by radiological evidence of disease. Data were collected on: gender, age, diabetes, HbA1c, smoking and immunodeficiency. Clinical presentation, facial nerve function, pathogenic organism, treatment course and adverse outcomes were reviewed. An adverse outcome was defined as: Greater than 4 months to resolution, deceased within 6 months and/or permanent facial nerve palsy.
Results: Forty-one patients were identified over a 10-year period, 30 matched our inclusion criteria. The mean age was 82.4+/-7 years and 83% were male (p<0.01). 70% were diabetic (p=0.022) of whom 48% had poor glycaemic control (p=0.74). A statistically significant percentage were smokers (70% p=0.042) and 10% were immunosuppressed. Facial nerve palsy was documented in 27%. The most prevalent organism was pseudomonas (67%). Significant disparity was observed in treatment. 40% of patients had adverse outcomes, of these 67% (8/12) were treated with less than 6 weeks of antibiotics, 22% (4/18) with non-adverse outcomes were prescribed less than 6 weeks of antibiotics (p=0.012).
Conclusions: Our findings provide evidence for the assumption that MOE affects elderly, diabetic males and furthermore sheds new light on a link between smoking and the disease. With a relatively high rate of adverse outcomes and such disparity in management, a more in-depth review of treatment is required.