Malignant otitis externa is a necrotizing infection of the external ear canal and surrounding soft tissue and bone, usually caused by Pseudomonas aeruginosa. The infection classically occurs in diabetic patients, however recently, several patients with the acquired immunodeficiency syndrome (AIDS) have been reported to have malignant otitis externa. A patient with AIDS who had malignant otitis externa with skull base osteomyelitis is presented and reported cases in patients with AIDS are reviewed. Predisposing factors include immunologic abnormalities (notably neutropenia), dermatitis, medications, neoplasm, and iatrogenic procedures, e.g., ear lavage. Treatment of malignant otitis externa has traditionally included anti-pseudomonal cephalosporins/penicillins and aminoglycosides for prolonged durations. Recently, ciprofloxacin has been shown to be effective as an oral regimen.
With the increasing number of patients with AIDS being seen in the outpatient clinics, the diagnosis of malignant otitis externa should be considered in any patient with persistent ear pain or otorrhea who does not respond to conventional treatment for external otitis.
PetrakR.M., PottageJ.C., LevinS.Invasive external otitis caused by Aspergillus fumigatus in an immunocompromised patient. J Inf Dis1985; 151(1): 196.
18.
CunninghamM., YuV.L., TurnerJ., CurtinH.Necrotizing otitis externa due to Aspergillus in an immunocompetent patient. Arch Otolaryngol Head Neck Surg1988; 114: 554–6.
19.
SobieS., BrodskyL., StanievichJ.F.Necrotizing external otitis in children: report of two cases and review of the literature. Laryngoscope1987; 97: 598–601.
20.
SolimanA.E.A rare case of malignant otitis externa in a non-diabetic patient. J Laryngol Otol1978; 92: 811–12.
21.
JohnA.C., HopkinsN.B.An unusual case of necrotizing otitis externa. J Otolaryngol Otol1978; 92: 259–64.
22.
LaneH.C., MasurH., EdgarL.C.Abnormalities of B-cell activation and immunoregulation in patients with the acquired immunodeficiency syndrome. N Engl J Med1983; 309: 453–8.
23.
LazzarinC., UbertiF., GalliM.Impairment of polymorphonuclear leukocyte function in patients with acquired immunodeficiency syndrome and with lymphadenopathy syndrome. Clin Exp Immunol1986; 65: 105–11.
24.
PoliG., IntronaM., ZanaboniF.Natural killer cells in intravenous drug abusers with lymphadenopathy syndrome. Clin Exp Immunol1985; 62: 128–35.
25.
FranzettiF., CernuschiM., EspositoR., MoroniM.Pseudomonas infections in patients with AIDS and AIDS-related complex. J Int Med1992; 231: 437–43.
26.
MorrisonA.J., WenzelR.P.Epidemiology of infections due to Pseudomonas aeruginosa. Rev Inf Dis1984; 6(Suppl 3): S627–S642.
RubinJ., CurtinH.D., YuV.L., KamererD.B.Malignant external otitis: Utility of CT in diagnosis and follow-up. Radiology1990; 174(2): 391–4.
34.
JohnsonM.P., RamphalR.Malignant external otitis: Report on therapy with ceftazidime and review of therapy and prognosis. Rev Inf Dis1990; 12(2): 173–80.
35.
SadeJ., LangR., GoshenS., Kitzes-CohenR.Ciprofloxacin treatment of malignant external otitis. Am J Med1989; 87(Suppl 5A): 138S–41S.
36.
LangR., GoshenS., Kitzes-CohenR., SadeJ.Successful treatment of malignant external otitis with oral ciprofloxacin: Report of experience in 23 patients. J Inf Dis1990; 161: 537–40.
37.
LevensonM.J., ParisierS.C., DolitskyJ., BindraG.Ciprofloxacin: Drug of choice in the treatment of malignant external otitis. Laryngoscope1991; 101: 821–4.
