Malignant Otitis Externa in a Tertiary Hospital, North Central Region of Nigeria: A 15-Year Review

Abstract

Abstract Context: Malignant otitis externa (MOE) is a rare, rapidly spreading, life-threatening invasive infection of the external auditory canal and the lateral skull base which typically affects elderly patients with diabetes and immunocompromised patients. Materials and Methods: Aretrospective review of records of all patients with a diagnosis of malignant otitis external seen at the otorhinolaryngology department over a 15-year period (2007–2021) was seen. Information retrieved included the biodata, the clinical presentation, the treatment modalities, and the outcome of treatment. These were entered into SPSS version 23 and analyzed descriptively. Results: A total of 431 case notes with a diagnosis of otitis external were retrieved, but only 18 cases (4.2%) were diagnosed as malignant otitis externa. The age range was between 43 and 90 years (mean age of 65.9 yrs = ±1.2). There were about 7 males and 11 females with an M:F ratio of 1:1.6. Right ear was affected in 62.5%, and left ear in 37.5% of cases. All the patients presented with otalgia (100%), 13 (72.2%) had a history of self-ear cleaning, about 50% presented with otorrhoea, about 37.9% had hearing loss, and 27.8% had facial nerve palsy. Culture results revealed Pseudomonas aeruginosa in 72.2% of the patients sensitive to ciprofloxacin, and they were treated with parenteral and topical ciprofloxacin impregnated with steroids with good outcomes and no mortality. Conclusion: Malignant otitis externa affects more female elderly patients with diabetes; the most common presentation was otalgia, with otorrhea with facial nerve involvement in 27.8% palsy, and the most common agent isolated was P. aeruginosa, which responded to parenteral and topical ciprofloxacin impregnated with steroids with no mortality recorded in our study.