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Clinical Guide - Malignant Otitis Externa

The following is some brief guidance on the management of malignant otitis externa. It is written with the intention of helping the Ear Practitioner to treat this aggressive and fatal disease and to know when to refer for specialist treatment. It does not replace a good knowledge of the underlying anatomy, physiology or pathology and these must be studied as well.

You should use this guide only after a careful history has been taken and an examination performed.

Remember these key features as, untreated, it is a fatal disease:


  1. This infection is aggressive and spreads across the skull base from the ear canal

  2. There is a polyp arising at the bony-cartilaginous junction of the floor of the ear canal

  3. It usually occurs in elderly and diabetic patients (but can occur in any late HIV/AIDS victim)

  4. It is caused by Pseudomonas infection usually and it is intensely painful

  5. As it spreads it destroys the facial nerve causing facial paralysis. It then destroys the vagus and glossopharyngeal nerves causing hoarse voice and difficulty with swallowing

  6. It then causes meningitis and death

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