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.
Osteomyelitis of the skull; Otitis externa - malignant; Skull-base osteomyelitis; Necrotizing external otitis
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 swelling may damage or destroy the bones. The infection may affect the cranial nerves, brain, or other parts of the body if it continues to spread.
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.
Dead or infected tissue may need to be removed from the ear canal. In some cases, surgery may be needed to remove dead or damaged tissue in the skull.
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.
Complications may include:
Call your provider if:
Go to the emergency room or call the local emergency number (such as 911) if you have:
To prevent an external ear infection:
Treat acute otitis externa completely. Do not stop treatment sooner than your provider recommends. Following your provider's plan and finishing treatment will lower your risk of malignant otitis externa.
Araos R, D'Agata E. Pseudomonas aeruginosa and other pseudomonas species. In: Bennett JE, Dolin R, Blaser MJ , eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 219.
Pfaff JA, Moore GP. Otolaryngology. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 62.
There are no recent clinical trials available for this condition. Please check back because new trials are being conducted frequently.