How is malignant otitis externa (MEO) diagnosed and treated?

Updated: Apr 13, 2020
  • Author: Brian Nussenbaum, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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The leukocyte count in malignant external otitis (MEO) is usually normal or mildly elevated. A left shift is not commonly found. The erythrocyte sedimentation rate (ESR) is invariably elevated, with an average of 87 mm/h.

Patients with known diabetes need an evaluation of the serum chemistry to determine if the infection is affecting their baseline glucose intolerance. Patients without a history of diabetes should be tested for glucose intolerance.

Culture from the ear drainage should be performed ideally before antimicrobial therapy is initiated. As mentioned, the most common causative organism is P aeruginosa (95%).

Imaging studies are important for determining the presence of osteomyelitis, the extent of disease, and response to therapy. They include technetium Tc 99 methylene diphosphonate bone scanning, gallium citrate Ga 67 scanning, indium In 111–labeled leukocyte scanning, computed tomography (CT) scanning, and magnetic resonance imaging (MRI).

Obtain a biopsy of the external auditory canal to exclude carcinoma or other etiologies.

Treatment for malignant external otitis (MEO) includes meticulous glucose control, aural toilet, systemic and ototopic antimicrobial therapy, and hyperbaric oxygen therapy. [3, 4] Surgery is now reserved for local debridement, removal of bony sequestrum, and abscess drainage.

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