Malignant otitis

Question 1

What?

Answer 1

Extension of otitis externa into the bone surrounding the ear canal (i.e. the mastoid and temporal bones).

Question 2

Risk factors?

Answer 2

Diabetes
Radiotherapy to head and neck
Elderly

Question 3

Signs?

Answer 3

Granulation tissue at bone–cartilage junction of ear canal; exposed bone in the ear canal.
Facial nerve palsy
Temperature over 39°C.
Exposed bone in ear canal (drooping face on side of lesion)

Question 4

Symptoms?

Answer 4

Pain and headache, more severe than clinical signs would suggest.
Vertigo.
Profound hearing loss.

Question 5

Investigations?

Answer 5

Plasma viscosity / C-reactive protein
Raised ESR
Radiological imaging
Biopsy and culture

Question 6

Treatment?

Answer 6

Glucose control
Aural toilet
Systemic & ototopical antibiotics
Surgery

Question 7

Surgery?

Answer 7

Local debridement
Removal of bony sequestrum
Abscess drainage

Question 8

What happens without treatment?

Answer 8

Fatal