Review Question - QID 102600

This elderly, diabetic woman is presenting with a fever and an external ear canal with inflammation, debris, and purulence suggesting malignant otitis externa.

Malignant otitis externa is seen almost exclusively in immunocompromised patients. The infection spreads from the floor of the ear canal to the nearby tissues including the bones at the base of the skull. The most common presenting patients are elderly patients with diabetes mellitus, though this condition can follow trauma to the external auditory canal. Patients will commonly complain of severe otalgia and purulent otorrhea. Other findings typically include a fever, elevated inflammatory markers, and possibly unstable vitals. Cranial nerves may be involved (the most common being CN VII). The diagnosis can be supported with a CT/MRI and confirmed with a biopsy. Treatment involves debridement and broad-spectrum antibiotics that cover for Pseudomonas aeruginosa.

Figure A demonstrates malignant otitis externa with granulation tissue in the auditory canal.

Incorrect Answers:
Answer 2: Mastoiditis presents with a fever and tenderness to percussion over the mastoid process. This can be a complication from otitis media/externa.

Answer 3: Meningitis presents with a fever, headache, photophobia, and meningeal signs. The diagnosis is confirmed with a lumbar puncture and treated with vancomycin and ceftriaxone for the general population.

Answer 4: Otitis externa presents in a young patient or a swimmer with external ear canal pain. The patient will generally be healthy and the only symptoms may be ear pain and some granulation tissue in the canal. The patient will otherwise be healthy and afebrile. Treatment involves an antibiotic wick in the ear canal.

Answer 5: Otitis media presents with severe ear pain and a distended tympanic membrane. Treatment can involve observation for 24-48 hours or amoxicillin.

Bullet Summary:
Malignant otitis externa presents in elderly and immunocompromised patients with a fever, ear pain, and granulation tissue/purulence in the external auditory canal.