Aka necrotizing malignant otitis externa
definition : aggressive and potentially life threatening infection of soft tissue of external ear surrounding structures quickly spreading to involve periosteum bone of skull base
CASE 1: A 45 yr old male having diabetes since past came to ENT opd with chief complaints of
Nocturnal otalgia since 1 month
blood stained purulent discharge since 20 days
He have facial palsy +9th 10th 11th nerve involvement
on otoscopic examination : Reddish tissue at cartilagenous and bony junction
C/s: pseudomonas +VE
his antibiotics sensitivity test shows resistant to antibiotics
How will you manage such case
Management :
Investigations :
1.CT temporal scan
2.Technetium 99 scan : Detects bone involvement before ct: remains +ve for 6 months
3,Galium 67 scan : Sensitive monitor of infecton
4.MRI
5.SPECT
TREATMENT:
1.Treat cause like Diabetes , immunocompromised state like hiv , drugs : steroids
2. Antibiotics : Ceftazidine 10-20 mg
Oral a/b : T. ciprofloxacin: 500-700mg for 2-6 months
3.Debridemnt of necrotic tissue
4. MRM or Radical mastoidectomy
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