Malignant Otitis Externa: A review of investigations and management

Malignant otitis externa (also known as malignant external otitis, necrotising otitis externa, necrotizing external otitis, skull base osteomyelitis and osteomyelitis of the temporal bone) is a rare and potentially life-threatening complication of otitis externa, historically with mortality rates as high as 60%. Management of this condition has varied over the years from radical surgical debridement to medical management only, to tempered combinations of the two. Malignant otitis externa is most often found in the elderly diabetic population and is associated with poor glycaemic control as well as immune compromise. Malignant otitis externa also has a predisposition towards the male gender. Due to the rarity of presentation and variety of management no randomised control trials exist for the management of malignant otitis externa. As a result of this there are no protocols to guide the management of malignant otitis externa. The majority of publications relating to malignant otitis externa are case-series and single case-reports. The paucity of randomised control trials arises from the rarity of condition and the ethical conundrum that would be presented by trialling different management. This review of 71 publications relates to MOE with particular attention to the success of medical, surgical and adjunctive therapies as well as radiological assessment and monitoring of disease. There is a lack of statistical significance in the existing literature, this review will not improve that; however amalgamating the current information will aid management of MOE by providing the necessary information to clinicians.